Schizoaffective Disorder Vs Schizophrenia: Differences

By We Level Up Editorial Team | Edited By Rebecca Hill | Medically Reviewed By Dr. Chris Small

Diagnosing mental health conditions like schizoaffective disorder vs schizophrenia can be complicated. The process leaves families confused and looking for answers. Whenever there are symptoms that intermingle, like symptoms of both psychosis and mood, a major diagnostic challenge arises.

In this case, the cost of an incorrect diagnosis is very high. Treatment type, recovery time, and stigma may impact the person’s living experience for years to come.

There is a clinical urgency to get it right. A quick and accurate diagnosis is important for stabilizing the patient and getting good results. This often needs special care, like inpatient mental health treatment.

The Diagnostic and Statistical Manual of Mental Disorders, or DSM-5-TR, as a tool, is the gold standard for diagnosis. Clinicians use it to assess complex presentations of symptoms. We are going to simplify these complexities and study symptom patterns, diagnosis evolution, and effective treatment variables.

Core Definitions & Diagnostic Criteria

As you traverse the diagnostic terrain, it is critical to understand the general definitions and distinguishing features of schizophrenia and schizoaffective disorder.

Schizophrenia

According to the DSM-5-TR, there are a variety of symptoms. To meet a schizophrenia diagnosis, the patient must be experiencing at least one of these core symptoms.

• Auditory input hallucinations (e.g., hearing voices)
• Visual input hallucinations (e.g., seeing people who are not there)
• Delusions ranging from persecutory to grandiose, or disorganized thinking

Importantly, mood is not a defining criterion. Mood episodes may occur at some point, but are not the defining feature. 

Schizoaffective Disorder

Schizoaffective is a different set of maladies. Dual pathology has psychotic symptoms plus major mood episodes (depressive or manic). Importantly, schizoaffective disorder includes psychotic symptoms persisting for two weeks or more with mood symptoms at any point.

Symptom Profiles: Beyond Overlap

Schizophrenia is often characterized by steady and progressive deterioration of social functioning. It also includes severe cognitive disorganization as a manifestation of psychosis. 

Symptoms of schizoaffective disorder include more dynamic social functioning and cognitive presentation. It acquires its value based on the severity of present or pending mood episodes. Impulsivity is a notable feature of manic periods.

Schizophrenia and schizoaffective disorders exhibit a greater degree of disruption in the form of psychosis.

Shared Psychotic Features

These include hallucinations, which are perceptions of things that are not there, usually sounds. They also include delusions, which are fixed false beliefs. These beliefs can involve feelings of being persecuted or having an inflated sense of self-importance.

Classes of Negative Symptoms

Anhedonia is the inability to feel pleasure. Avolition is the inability to start or continue goal-directed behavior. These symptoms are often more severe in schizophrenia. This condition also includes a strong sense of emotional blunting.

Symptom Profiles: Beyond Overlap

People with schizoaffective disorder have distinctive mood components. They have clear, chronic major mood episodes.

This can be major depressive disorder or mania.

Depressive disorder symptoms include:

• Suicidal ideation
• Severe fatigue
• Feelings of worthlessness

For those experiencing these symptoms, depression treatment can be a critical component of care.

Mania symptoms include:

• Risk-taking behavior
• Sleeplessness
• Racing thoughts

In schizophrenia, mood problems can happen but are not the main issue. People may feel sad or depressed because living with psychosis for a long time can be very hard and lonely.

People with schizophrenia often have more trouble with social life over time. They may pull away from others and have a harder time functioning. In schizoaffective disorder, social life can improve when mood symptoms get better.

Treatment Strategies for Schizoaffective Disorder Vs Schizophrenia

Treatment for schizophrenia and schizoaffective disorders is highly individualized and primarily pharmacological. Antipsychotics are utilized to treat psychotic symptoms for both disorders. For example, hallucinations and delusions, using medications like risperidone.  

The treatment for schizoaffective disorder is more complicated. This is because it includes both mood and schizophrenia symptoms. The bipolar type of schizoaffective disorder requires mood stabilizers, e.g., lithium, to rid acute manic episodes.

For the depressive type, SSRIs (Selective Serotonin Reuptake Inhibitors) are routinely used. However, with some caution because they could also exacerbate psychotic symptoms.

The solutions of adherence must be addressed since they are chronic illnesses. Long Acting Injectables (LAIs) are helpful for those who are unreliable with medication.

Families need psychoeducation, including what to expect, medication timetables, and compliance to support them for the long haul.

Prognosis & Functional Outcomes

There are important differences in the long-term outlook and daily life of people with schizophrenia and schizoaffective disorder. This is due to the differences in core symptoms and response to treatment.

Schizophrenia

In general, schizophrenia has a chronic course with about 70% experiencing moderately to severely impairing symptoms (“lifelong disability”). If patients take medication, relapse rates are much higher. This is partly because many do not take their meds consistently. This is very important, especially for those with schizophrenia. 

Schizoaffective Disorder

People with schizoaffective disorder often recover better than those with schizophrenia. This is because their mood can be stabilized more easily. However, this disorder also carries a higher risk of suicide, especially during depressive episodes. Regular checkups and proper medication can help lower this risk.

Global Statistics

Around the world, about 1% of people have schizophrenia. Schizoaffective disorder is less common, affecting about 0.3% of people.

This number might be lower than the real rate because the disorder is complex and can be hard to diagnose correctly. Misdiagnosis or underdiagnosis makes it difficult to know the true number of people affected.

Responding to Crises: Family & Clinical Response

Crises in the context of schizoaffective vs schizophrenia require fluid and immediate attention at both the family history level and clinical level. Managing crises appropriately is crucial to safety and long-term outcomes. 

De-escalation

In the case of acute psychotic symptoms, it is ideal to de-escalate situations quickly and safely. It is better to clarify and validate a person’s feelings. For example, you can say, “That sounds scary,” or “I can see you are upset.” This approach is more helpful than directly challenging their delusions or hallucinations.

These hallucinations are signs of the illness. Challenging someone about their reality can increase their agitation and mistrust. This can be more complicated when suicidality or violence is posed because definitive emergency protocols must be determined. There are many helpful resources available across the United States that can help.

This can start quick help from trained counselors for people and families in crisis. It will create a support connection. Many places around the world have emergency mental health services. It is helpful to know the emergency number in your area.

Diagnostic Pitfalls

During a crisis, it can be very hard to tell the difference between mental health disorders that look alike. One common mistake in diagnosis comes from drug use. Using drugs for fun, such as cannabis or LSD, can cause symptoms that seem like psychosis. They can even trigger a short-term psychotic episode. That’s why patients should have a drug test to make sure substance use is not the cause.

Another common mistake is confusing mood disorders with psychotic features and schizoaffective disorder.  Mood disorder episodes, especially depressive or manic episodes, may have psychotic symptoms.

To diagnose schizoaffective disorder, a person must have at least two weeks of psychosis. This must occur without a major mood episode. It can be tough to see the difference during a crisis. However, knowing it is important for making the right long-term diagnosis and treatment plan.

So, What Is the Difference Between Schizophrenia and Schizoaffective Disorder?

The key difference between these disorders is the presence of mood symptoms. Schizoaffective disorder includes the feature of psychosis, along with present mood episodes.

Mood changes are a stronger and more constant part of schizoaffective disorder. Schizophrenia mainly includes psychotic symptoms. Mood problems are less important and may only show up sometimes.

The most important step for anyone with these symptoms is to get help. If you have mood or psychotic issues, it’s important to see a mental health specialist for an evaluation.

An evaluation can only do so much. Assessment covers a long period of time and allows clinicians to observe the course of symptoms. There will be some reality-testing involved, and early intervention would have the most impact on functional outcomes. That way, the onset of better long-term stability.

In the end, the key message is hope. Both schizoaffective disorder and schizophrenia can be treated with therapy and medication. Though they can be hard to manage, people can learn to live stable and fulfilling lives. Talking to a mental health professional is the best way to understand these conditions and how they differ.

Are you, your family member, or a friend having mental health problems? Reach out to We Level Up Washington rehabilitation center for diagnosis and treatment.

Call today to speak with our team and learn more about our programs. We Level Up Washington: (509) 348-4077. Your next step starts here.