What is schizoaffective disorder? Is it worse than bipolar disorder? That's what I'm talking about today. I'm Dr. Tracey Marks, a psychiatrist, and I make mental health education videos. This video is based on
several viewer questions. Saxon Survival says, "I was just diagnosed "with schizoaffective
bipolar disorder type. "Can you make a video
explaining more about this? "Is it worse or better than having "just schizophrenia or bipolar?" And then Bipolar Corner
says, "Dr. Tracey Marks, "could you please do a video diving deeper "into what schizoaffective
disorder is like, "the signs and symptoms, and discuss "some of the ways of treating it please? "Thank you." Thank you Saxon Survival
and Bipolar Corner. I know that Bipolar Corner started his YouTube channel talking about his struggles with bipolar disorder, and then his diagnosis changed
to schizoaffective disorder. These kinds of changes can happen when your illness progresses
and your symptoms evolve more. Schizoaffective disorder is a combination of schizophrenia and a mood disorder, either bipolar disorder or depression. Where does the term affective come from? In psychology, there's a concept called
the ABCs of psychology. It divides the mind into three domains. A is for affect, which is your emotions or feelings.
(chuckles) B is for behavior
(motor revving) and C is for cognition,
which is how you think. (dings) Mood disorders like depression and bipolar disorder primarily affect your emotional expression, so they're called affective disorders. Whereas schizophrenia, at its
core, affects your thinking, so it's more of a cognitive disorder. With schizoaffective disorder, you get a combination of the alterations in your emotions and
your thinking abilities. There's still a debate within
the psychiatric community as to whether or not
schizoaffective disorder should be a separate disorder from schizophrenia because symptom-wise
schizoaffective disorder really looks more like schizophrenia than it does bipolar
disorder or depression. That is, people with
schizoaffective disorder are more on the schizophrenia
spectrum than the mood spectrum. I did a video where I explain
what schizophrenia is. You can see the link in the description and in the corner of this video. But the gist of it is that
schizophrenia is a disorder where a person has psychotic symptoms as well as cognitive symptoms. The psychotic symptoms are hallucinations, delusions, or severe thought
or behavioral disorganization. A person with schizophrenia
isn't necessarily depressed. They may get agitated,
but that agitation is not the same as mania. Mania is an elevated or irritable mood along with other things,
like increased energy, a decreased need for sleep. The person with pure schizophrenia isn't experiencing these things. So what happens with
schizoaffective disorder is you have a depressive illness or bipolar illness superimposed
on the schizophrenia. The diagnosis that you'll
get is called schizoaffective bipolar type or depressive type. Here's how the illness looks different from bipolar disorder or depression, and for the sake of this example, let's just look at the bipolar type of schizoaffective disorder. With bipolar disorder,
you have separate episodes of mania and depression. In between those episodes
you either have no symptoms or very few symptoms of
whichever episode you last had. Now, you can become
psychotically depressed or you can have mania
with psychotic symptoms. In this case, though, the
psychosis is a measure of the intensity of the illness, and the psychosis resolves
as the episode improves. So here's how it would look for just pure mania that's
part of bipolar disorder. Let's say you become manic and you start believing that you're a part of a sting operation
spearheaded by the CIA, and the CIA has recruited you
to do your own investigation. So as part of that manic episode, you start staying up all night, researching on the internet,
(subsonic humming) but when you start taking medication, you settle down and you no longer believe you're a part of the sting operation. But you still have some manic symptoms, like you may not be sleeping or you may have pressured speech and you just can't stop talking,
but you're thinking rationally. As your manic episode
continues to resolve, everything slows back down. Now, let's take this same scenario with schizoaffective disorder. In this case, before your mania starts, you already are believing that the CIA is gathering intelligence on people, and because of that, you refuse to answer the phone because you feel like signals
are coming through the phone. Notice with this delusion it's a little more bizarre and unbelievable
than with the manic delusion. Then you start losing sleep and you start believing that
you're being recruited to help with the surveillance, so you go through your mania, but after your mania resolves, you still believe that the CIA is doing something evil, or you no longer believe the CIA thing, but you've moved on to a different kind of conspiracy and you continue to have this delusion for a little while until it tapers off and
you stop thinking about it. But as it's tapering off, you're neither depressed nor manic. Now, this can get complicated because you can have schizophrenia
and major depression as a second illness without it being schizoaffective disorder, and the difference here is that, with schizophrenia plus major depression, you spend more time with
psychotic symptoms relative to the amount of time you
spend in a depression. So you're mostly psychotic
with these pops of depression. With schizoaffective
disorder depressed type, for most of the illness you're
both psychotic and depressed, and you'll have psychotic symptoms before or after your
mood symptoms resolve. When it comes down to it, though, there's only minor differences in the kind of treatment
that you're gonna get. A person with bipolar disorder is going to be on mood stabilizers. If you have bipolar disorder, your medication regimen
may change depending on the state of your illness. What it took to get you better may not be the same medication
that keeps you better. Lemme put it a different way. Sometimes the medicine
that your doctor uses to treat an acute
episode will be different from the medications used when you're in the maintenance phase. The maintenance phase is the period where you're either without any symptoms or have very few symptoms, and the goal is to prevent another episode or at least control the
onset of another episode. The main medications that we use to treat bipolar disorder
are mood stabilizers, and these are anticonvulsant
mood stabilizers, like valproic acid or lamotrigine, and then there's the
antipsychotic medications, also called neuroleptics. They're also used for mood stabilization. A person with bipolar disorder will be on a mood stabilizer that may or may not include a neuroleptic, but the person with schizophrenia will
be only on a neuroleptic. If you have bipolar II disorder, you may also be on an antidepressant at some point during your illness. I have another video talking about when you do and do not
wanna take antidepressants for bipolar disorder. A person with depression will be on an antidepressant, and if you become psychotically depressed,
you may take a neuroleptic for a temporary period of time, or if you have
treatment-resistant depression, you may have a neuroleptic
added to your antidepressant. So there is some overlap between these illnesses and the medications that you can take, so you can't always look at someone's medication list and work backwards to know
what their diagnosis is. Probably the best way to think about comparing the treatment
between bipolar disorder and schizoaffective
disorder bipolar type is, with bipolar disorder you may
or may not take a neuroleptic, but with schizoaffective disorder, you will always need
to be on a neuroleptic. So getting back to the question of whether or not
schizoaffective disorder is worse than bipolar disorder. In some ways, yes, because
you've got bipolar disorder with the additional burden
of a chronic psychosis. If you have bipolar II disorder, you may never become psychotic, but the bigger issue is that, since schizoaffective disorder is thought to behave more like schizophrenia, you get the cognitive decline that you don't get with bipolar disorder. Yes, when you are depressed or manic you can have thinking problems, but a schizophrenia
spectrum illness affects your thought processing,
problem-solving abilities, judgment, and insight in a much bigger way than it does with bipolar
disorder or unipolar depression. Check out this video on when not to take antidepressants
for bipolar disorder. See you next time.
