What are the differences between schizoaffective disorder and schizophrenia? While they both share the prefix “schizo,” they’re two separate diagnoses.
Hosts Rachel Star Withers and Gabe Howard divulge their personal experiences with psychosis, schizophrenia, and mental health conditions as they explore the newer termed condition of schizoaffective disorder.
Guest Dr. Michelle Maust from MindPath Care Centers joins to give a medical perspective on the differences in diagnosing these disorders.
Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.
Rachel Star Withers: Welcome to Inside Schizophrenia, a Psych Central Podcast, which is proud to be with Healthline.com. I’m your host, Rachel Star Withers here with my wonderful co-host, Gabe Howard.
Gabe Howard: Hey, everyone.
Rachel Star Withers: And in today’s episode, we are going to be exploring the differences between schizoaffective disorder and schizophrenia, Gabe, it seems simple at first and then it got really complicated. I feel like that’s like all of our episodes. Like when I first look at the topic, I’m like, oh, this will be easy. And then when I like really research and get into it, what happened? This is confusing.
Gabe Howard: I think that we’re definitely explaining why mental illness is so difficult to understand, people think depression and sadness are the same thing, right? So let’s move that aside. It’s like schizoaffective and schizophrenia. They both have schizo, so therefore they must be the same thing. But, yeah, that’s completely false.
Rachel Star Withers: We’re going to be exploring all of that, and we also have the wonderful Dr. Michelle Maust from MindPath Care Centers, who’ll be joining us to give us the doctor’s perspective on all of this.
Gabe Howard: And she is wonderful. She’ll be coming up a little later in the show.
Rachel Star Withers: The very basic definition of schizoaffective disorder is it’s schizophrenia with an added mood disorder similar to bipolar. The prefix schizo refers to psychotic symptoms of schizophrenia that affect a person’s thinking, sense of self, perceptions. And then the term affective refers to extremes, shift in mood, energy and behavior. So right away, I’ll tell you, I’m already confused because I feel like schizophrenia itself is just extreme shifts in everything.
Gabe Howard: Well, right, but
Rachel Star Withers: Yeah.
Gabe Howard: As we learned from the What Is Schizophrenia? episode, it’s not so much those extreme shifts, which are what people see, but it’s the adding of features and the removing of features. And that’s how you get a schizophrenia diagnosis. So some of this is really just narrowing down the diagnosis, which, of course, allows doctors to narrow down treatment opportunities. And that’s really important.
Rachel Star Withers: And all of this falls under the heading of mental illness, and under that you also have different mood disorders and psychotic disorders. So a mood disorder that’s usually involving intense and sustained sadness, melancholy or despair. That should be known as major depression, milder but still prolonged depression can be diagnosed as dysthymia. Bipolar disorder is, of course, a mood disorder, also formerly known as manic depression, and that involves abnormally high or pressured mood states, mania, alternating with normal or depressed moods. Now, schizophrenia is classified more as a psychotic disorder. So the psychotic disorders are the patterns, belief, language, perceptions of reality that become distorted. So we’re talking about your hallucinations, your delusions, any kind of delusional type disorders. Now, Gabe, you I’m going to I’m not meaning to call you out here, but you do have bipolar.
Gabe Howard: I do.
Rachel Star Withers: Yeah. You are the expert. So that’s classified as a mood disorder. So can you explain to us what bipolar is to you and how does it affect your life?
Gabe Howard: This, of course, is the interesting part of mental illness, it’s not one size fits all. The symptoms that impact me the most may not be the symptoms that impact somebody else the most. So that’s the first thing that I want to say right up front. Now, for me, depression and mania and a skosh of psychosis is really what gets me the most, especially the mania, the grandiose thinking and then thinking that people are watching me. I have delusions. Other people with bipolar disorder may not have as much mania or the mania may be easier for them to control, but it’s the depression that gets them. And even as I’m saying this, I think, you know, the time that I had that really bad depression spell was extraordinarily difficult. Maybe I shouldn’t just gloss over that so quickly because I’ve had and I’m making air quotes more mania.
Rachel Star Withers: How would you describe a manic episode or that mania that you experience? Take us through that.
Gabe Howard: The best way that I can describe mania is it’s a consequence free environment. Whatever is happening in the moment is the only thing that you care about. And you see this in things like where people spend all of their money that they need for their rent. And you think, well, how could you do that? Your rent is due in a week. Well, yeah, but that’s not in the moment. That’s not right now. Right now I have five hundred dollars. I’m going to spend it right now because rent is not due right now. Having the ability to think toward the future is something that mania easily strips away from the person. The next thing is, is it creates this filter where you see whatever you want to see. For example, let’s say that I do something wrong and a whole crowd of people are yelling and booing at me. The mania filter, it shows me those people cheering. It shows them happy and paying attention to me. I get what I want. So therefore my behavior will escalate because after all, they’re cheering, they’re happy, they’re excited. Those are really just huge hallmarks. Obviously, the inability to focus, you really don’t get anything done. You’re thinking, it’s always extraordinarily positive, even though there’s absolutely no data to show that anything positive is happening.
Rachel Star Withers: And how would you describe your depressive episodes with bipolar?
Gabe Howard: Depression works very much the same as major depression stand alone, for lack of a better way to describe it. It’s a pit, it’s darkness, it’s hopelessness. It’s no path forward. It’s heavy. It just feels empty. And like whatever is happening in that exact moment is how it’s going to be forever. And what’s happening is that exact moment is that your brain is like you are worthless. Your mother doesn’t love you. Your co-host, Rachel, hates working with you. Don’t bother getting up. You’re stupid. And when all of that is just sort of repeating over and over again, it just kills any motivation or desire that you have to move forward in a positive way, which, of course, becomes this deep, dark, hopeless pit of despair.
Rachel Star Withers: So schizophrenia plus components of bipolar, that’s schizoaffective disorder, that’s the easiest way to break it down. Originally schizoaffective was considered to be a subtype of schizophrenia back when they had different subtypes. It was kind of kind of thrown under there, maybe. Then it was considered a separate psychotic disorder. And they were like, you know what, it’s not schizophrenia, but we’re not really sure what it is. It’s something, though. And in the DSM-5, so that’s the Diagnostic and Statistical Manual of Mental Disorders, and that is one of the major diagnostic books used in the world, but mainly used in America also. And it categorized schizoaffective under the category of schizophrenia spectrum and other psychotic disorders, it’s listed in the spectrum and it has two different types. You have a bipolar type, which includes mania and sometimes major depression, and then you have a depressive type. So that means you only have the depressive episodes, which is interesting to me that they split that up, that you have the bipolar side and then you also have just the depressive side of it. Even just trying to say what does the American Psychological Association classify it as? It gets confusing so quickly. It’s like, no, they’re not even sure either. It’s been bounced around.
Gabe Howard: It’s very important to point out that in a way that’s good, right?
Rachel Star Withers: Yes.
Gabe Howard: There’s no authoritative this is what it is. This is what it will always be. Research is ongoing. That being said, it does present patients like Rachel and I with sort of a scary proposition. Is this the best path forward for us? And the answer is for today, yes. But always keep working with your doctor. Keep on top of the latest research, find out what’s going on. And new treatments are becoming available all the time.
Rachel Star Withers: Oh, yes. To actually be diagnosed with schizoaffective disorder, there’s a few different things that would have to happen. You would need to have two or more of the following for a significant amount of time during a one month period. Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and then different negative symptoms. You would also need to have hallucinations and delusions for two or more weeks in the absence of a major mood episode, either manic or depressive.
Gabe Howard: You know, that alone is a lot, but I understand there’s two more. Correct, Rachel?
Rachel Star Withers: Yes, symptoms that meet the criteria for a major mood episode have to be present for the majority of the total duration of the active and as well residual portions of the illness. And of course, none of this can be caused by any substance abuse or medication or underlying medical issue. So right away, the thing that stands out to me, Gabe, is there’s time frames. And as someone with schizophrenia, I am not good with those. So I can imagine, like having a hallucination, having a psychotic episode, and then someone asking me, trying to say, how long has this been going on? I meet with a counselor every two weeks and she says, How long is this and how long has this been happening? And I’m like, Oh, I don’t know. I just know it happened. I don’t know. It’s just big red flags to me because I know for myself I have the hardest time trying to express time. Right away, I’m this is confusing.
Gabe Howard: As longtime listeners of the podcast know, mental illness and schizophrenia, they’re diagnosed by observation, you’re giving information to the doctor. Now, this presents a challenge, as Rachel said, trying to figure out how long something has lasted. If we’re really honest with ourselves, it’s difficult, period. Remove mental illness. I talk to my father all the time and he’s like, well, you know, I remember you were five. I’m like, Dad, that was, that was four decades ago. And he’s like, oh, time just flies. So that’s just normal. That’s just normal everyday life. Trying to remember how long it’s been, how long ago something happened. So now put an illness on top of that. You’re actively hallucinating or having a delusion, and you’re supposed to know how much time passed and you’re supposed to know whether or not you had a major mood disorder while that was occurring. And this is, of course, where our friends, our family, our caregivers. our, you know, whomever is in our lives and whatever role they play can be extraordinarily helpful in our treatment. This is in my opinion, it’s one of the greatest roles they can play, is helping us remember what happened. Let’s be honest. It can take two, three, four or five, six months to see a psychiatrist or a psychologist. And that’s a lot of time to remember, especially when sick.
Rachel Star Withers: Yes. A few interesting points, schizoaffective disorder usually begins in the late teens or early adulthood between the ages of 16 and 30, which sounds very similar to schizophrenia. However, it occurs slightly more in women than men and is very rare in children. Audio hallucinations or hearing voices are the most common of the psychotic symptoms. That’s true of schizophrenia also. But I don’t know, Gabe. I did think it was interesting. They said the visual hallucinations just are very rare with schizoaffective disorder. Studies also suggest that schizoaffective disorder is far less common than schizophrenia, bipolar or depression alone. And to treat schizoaffective disorder, it is pairing antipsychotics with antidepressants.
Gabe Howard: It’s important to note that the primary medication treatment is pairing antipsychotics with antidepressants, but there’s also therapy, there’s also coping skills, there’s also support groups. And of course, there’s also learning on your own, like listening to awesome podcasts hosted by Rachel Star Withers.
Rachel Star Withers: Oh, yes, yes. I guess it’s obvious to me that, yeah, treatment would be antipsychotics and antidepressants because isn’t that kind of like, well, that’s the treatment for most mental disorders. I don’t think that I’ve ever had a close person with schizophrenia that wasn’t on both antipsychotics and antidepressants. I just I’ve never spoken with another schizophrenic who said, oh, yeah, I’m just on antipsychotics. As far as bipolar and knowing people who’ve been treated with bipolar, are they on antipsychotics often or is it more just antidepressants when it comes to treating bipolar?
Gabe Howard: The treatment of bipolar disorder, mood stabilizers are a big, big key. It is not uncommon for somebody with bipolar disorder to be on a mood stabilizer and an antidepressant or a mood stabilizer and an antipsychotic or a mood stabilizer, an antidepressant an antipsychotic and an anxiety disorder medication. It’s it really is your body, your symptoms. But the gold standard for bipolar disorder is that mood stabilizer, and that’s where it really differs from schizophrenia.
Rachel Star Withers: Let’s talk about the specific differences between schizoaffective disorder and schizophrenia, because schizoaffective disorder can often be misdiagnosed when the correct diagnosis may actually be psychotic depression, psychotic bipolar disorder or schizophrenia itself. And this, this has been a, I don’t want to say annoyance, but I guess maybe a worry of mine, Gabe. This past year where I’ve had to see multiple new psychiatrists, a few of them have actually brought up, oh, you’re not schizophrenic. You have schizoaffective disorder. And they’ve all brought this up with them talking to me for five minutes where I’m like, OK, well, first of all, no offense, I don’t know you. So I’m also holding back a lot. I don’t just like walk in and be like surprise. Guess what? Let me tell you all of my issues. I always like softball it in there, but the minute I say I have depression and schizophrenia, they’ll always want to say, oh, well, then you don’t have schizophrenia. And I guess that’s confusing as a patient because it’s like, OK, well, I’ve had this diagnosis of schizophrenia and originally it was paranoid schizophrenia and dysthymia, which is persistent depression, since my early 20s. And originally I had all these tests done and actually looked them up because I’m like, why did that one psychiatrists and psychologist do a bunch of tests on me and no one has ever since then? I’m not sure. But they did all these tests and I really like that I have these pages and pages of testing that they did and that was the diagnosis. And then to have someone talk to me for five minutes and be like, oh, well, that’s wrong. I feel like even in the medical community, they’re very quick to switch diagnoses. That it’s too easy to misdiagnose people.
Gabe Howard: The reality, Rachael, is that it is very easy to misdiagnose people and some studies show that as high as 50% of people with schizophrenia also have comorbid depression. And it’s all self reporting. Right. And a key word that I want to draw people’s attention to is that you said that you were holding back when you talked to your psychiatrist, the new one. Now, sometimes we do that accidentally. Sometimes we do that because we forget. Whatever the reason, when it is self reporting, it can be difficult to try to sum up the last one, two, three, four or five, six months worth of symptoms and life in a 15, 30, 45 minute appointment with the psychiatrist who now has to make a diagnosis. I think the question that I want to pose to you, Rachel, is how do we tell the difference between schizophrenia, schizoaffective disorder, schizophrenia with comorbid conditions? It does become a nightmare. And as a fellow patient, I just wish there was a blood test. They would tell me what I have and we move
Rachel Star Withers: Yes,
Gabe Howard: Forward. Like that would be so handy. We’re not there yet.
Rachel Star Withers: No, no, sadly not, that would be amazing.
Gabe Howard: Yeah, wouldn’t that be great, but I guess to pin the question down perhaps a little further, what is the big, big difference between schizophrenia and schizoaffective disorder?
Rachel Star Withers: Overall, schizoaffective tends to be more episodic, so the psychotic symptoms kind of tend to come and go, whereas with schizophrenia you’re more likely to have them all of the time. Schizoaffective, you might have intervals where you’re completely symptom free. With schizoaffective, the psychotic symptoms may or may not be present during the times when you’re experiencing the depression or mania. Schizoaffective disorder also tends to not have a decline in mental functioning. That was interesting to me as someone with schizophrenia, who especially the past five years, I’ve been kind of tracking my, I don’t want to say mental decline, but I have been. I would just think it would be the same for both. But that goes back to the wonders of the mind, not knowing how things work.
Gabe Howard: I’m fairly certain that I know the answer to this question, Rachel, but do you think that you have schizoaffective disorder?
Rachel Star Withers: I stand by my original diagnosis that, no, I just have schizophrenia and depression, and the reason I say this is because I don’t really have episodes. I am always hallucinating, which is funny because people say, well, how often? And I’m like, I mean, 90% of the time. I’m just for me it’s a constant. Since I was a little kid, I would see faces in trees and it’s weird. I can look at like the carpet and I start seeing faces. My everyday activities, I hear ticking, scratching in walls like it’s just it’s just it never ends. And I’ve just kind of learned to live with it. It’s not like, oh, God, poor Rachel. It’s like, no, it’s just, you know, it’s always there. I can’t think of a time when I’d be like, oh, wow, yeah, I stop seeing faces or I was able to look in the mirror and not have problems. It’s just it really is a constant. Now, so is my depression, though. I’ve always been depressed. And you didn’t mean to the other day, but you actually made me really, really sad because I have started a new depression treatment and you were asking me how it was going. Like, again, you were being very nice. You did nothing wrong, but you said, well, are you experiencing joy? And I just thought, like, it caught me because for what I’m thinking, I don’t think I ever used the word joy. I associate it with, like a holiday type thing, Joy. I don’t know. But I can count.
Gabe Howard: Well, it was, it was over the holidays.
Rachel Star Withers: It was yeah, yeah, and again, you were being nice, you did nothing wrong, but just the way you asked it and the fact that I in my mind, I was like, never. I’ve never had that.
Gabe Howard: Never?
Rachel Star Withers: And I can count on my hand how many times I’ve been happy. I can actually tell you the times when they were. When you were talking about depression earlier in this podcast, in the beginning, I was even thinking that’s different than my depression. Now I’ve had that. But mine is just a constant I don’t want to be alive. Not a constant I’m trying to kill myself. There’s a difference. I’m not actively suicidal. I have been at times in my life. But there’s always just this constant of not wanting to exist and being down. My description of what I feel. And again, everybody’s different. We all experience things differently. I just don’t feel that fits with the definition of the schizoaffective disorder. I feel it fits kind of almost textbook like of schizophrenia and depression. We talk that you can have bipolar with psychosis, which is different than schizoaffective disorder. What’s your interpretation of how is bipolar with psychosis different than schizoaffective?
Gabe Howard: So the first thing that I want to say, Rachael, is that it’s very confusing, right? I don’t know that I would be in the position to disagree if my doctor suddenly changed my diagnosis. Now, I will say that I’ve seen my doctor for going on a decade now. If suddenly she came to me and said, Gabe, I’m changing your diagnosis, I’d be like, oh, well, you’ve seen me for 10 years. You must have the data to do it. So it’s not exactly the same as your situation where it was a new treatment provider. And you’re like, well, now wait a minute. But when it comes to bipolar with psychosis, you know, bipolar disorder is the highs and lows, the highs and the lows, the spectrum, the moving back and forth, right? And, you know, the grandiosity, the depression, just everything. And then with psychosis, you’ve also got these things following you around, you know, these delusions. For me, it’s delusions. I feel that there’s somebody under my bed. I feel that there’s somebody watching me. I feel. When I say feel, I mean like I believe with every fiber of my being that there is somebody under my bed.
Gabe Howard: And even when I look under the bed and they’re not there, that just changes my thinking to they were there, but they got out. They knew that I was going to look. I know it, but I never see them and I never hear them. That’s very important. When it comes to schizoaffective disorder, I just think that it’s a whole nother ball of wax. I mean, it’s got a lot in common in the same way that a Big Mac and a Whopper have a lot in common. You know, essentially, at the end of the day, a Big Mac and a Whopper, you know, bun, meat, topping, boom. But I think that most people think that there is a significant difference between a Big Mac and a Whopper. I think that there’s a significant difference between bipolar with psychosis and schizoaffective disorder, although, again, they have a lot in common. They don’t sound the same to me as a patient, as somebody who lives with bipolar disorder and as a layman. And I’m not quite sure that I can articulate why, except to say that Big Macs are not Whoppers and Whoppers are not Big Macs, even though they’re both essentially the same thing.
Rachel Star Withers: You know, this controversy isn’t just patients trying to understand it like us laypeople, but it’s also in the medical community. They’ve had many issues with the diagnosis of schizoaffective. Some doctors believing that you should or shouldn’t rediagnosed people. One review actually found that schizoaffective disorder was incorrectly diagnosed one third of the time.
Gabe Howard: Wow.
Rachel Star Withers: That’s a lot.
Gabe Howard: That is a lot.
Rachel Star Withers: The good thing, though, as we already pointed out, is the treatment for schizoaffective disorder is antipsychotics and antidepressants, which also seems to be the main treatment for the other disorders it might be misdiagnosed as. So it’s not like you’re necessarily, if you were misdiagnosed, getting the wrong treatment, but not the best thing to have. Another problem is that schizoaffective is not a stable diagnosis. So, a stable diagnosis means if you diagnose someone and then when you check up on them at a six month mark and then a 24 month mark. So a stable diagnosis is one that you’re like, OK, this person still clearly has this. Schizoaffective usually only stays the diagnosis 36% of the time. Whereas when people are diagnosed with schizophrenia and they’re checked up at six month and 24 month marks, 92% of the time, they’re still like, yeah, no, you still got schizophrenia. Bipolar is actually 83%. Those are big percentages.
Gabe Howard: Rachel, obviously, everybody likes this idea of you go to a doctor, you get a confident, specific, non changing diagnosis with the cure, I mean, why are we even saying treatment? Let’s just go with cure. That’s not reality in mental health. That’s not reality in physical health. That’s not reality in why we go to doctors. Everybody’s different. Even if you have a physical health diagnosis, it can change and things can add on. There’s comorbid disorders. And perhaps it’s because the onset of schizophrenia and schizoaffective disorder is 16 to 30. These are individuals that don’t have a lot of experience, probably, with medical issues. But I do believe that if you ask any 60 year old, hey, is your doctor changing your medications, changing your diagnosis, tweaking what is going on in your life? They’d be like, well, yeah, that’s why I go to a doctor, because they have to keep up with me. That is the purpose of having a doctor because it is, in fact, constantly changing.
Rachel Star Withers: And also, during this time, you’re hopefully going to therapy, you’re receiving different treatments, learning different skills to deal with this new disorder that you’ve been diagnosed with. It changes. The things that might have been really bad in the beginning, you might now have a better handle on. I know it’s been brought up to me a couple of times that I wasn’t having psychotic episodes. I’m like, oh, no, I still do. I’m just really good at dealing with them now, you know? So on the outside it would be like, oh yeah, no, Rachael’s able to hold a job. She’s able to do this. So she clearly doesn’t have that problem. It’s like, oh, no, it’s it’s very much still there. Honestly, it doesn’t bother me as much just because I’ve had it for so long. And we go back to that self reporting. I think it’s so important, Gabe, because to the outside sometimes, yeah, it might look like a person is doing great and they are still dealing with all of these things. They’ve just got better at dealing with them. You know, when we look at trying to classify all of these disorders, I think it’s a good and bad thing. It’s good because the world’s still like exploring and trying to figure it out.
Rachel Star Withers: And as someone who once felt alone, and I’m sure you did too at some point with your mental disorder, Gabe, it’s funny because everyone’s like we feel so alone and then you find there’s so many other people and it’s kind of like reassuring to find what you experience in a book. And you’re like, oh, wow, this is the thing that’s like so common. It’s in this book. There’s a word for what I am like. I’m not the only person with this. It’s kind of nice to be able to say, like, oh, wow. Like I’m a textbook example literally of this thing. I’m not alone in the world dealing with this, but it can get very convoluted also. And then, of course, we have science. I feel like the genetic discoveries soon are going to really just blow up the entire DSM manual and all of the terms we have. I really think once they figure that out, it’s going to be like all new things because we’re just scratching the surface on what we know. Our last episode where we talked about the evolution of schizophrenia treatment, I mean, it’s completely different from one hundred years ago, like everything we know.
Gabe Howard: It’s amazing. That was an incredible episode to talk about the same illness. Largely diagnosed the same way, self reporting and observation, but the way that it is treated and the outcomes couldn’t be more different. That is both amazing and like incredibly depressing. Right? Because
Rachel Star Withers: Yes, yes.
Gabe Howard: Rachel Star in 1950 would not have fared as well as Rachel Star in 2020.
Rachel Star Withers: And what about Rachel Star in 2030? Like, can you imagine, in just 10 years, I honestly think so much will have changed in what we as a society understand about the brain and the way it works. I’m not an expert. Gabe keeps bringing it up. I’m not a doctor. I know. But I personally, I like the idea of schizophrenia spectrum. I kind of like it as being a big umbrella term. And you could kind of move around on the spectrum. You have worse days, better days, different times in your life. You might be in worse psychotic episodes. I like that vs. rigid classifications. In your opinion, Gabe, what do you think is the best way to label mental disorders or illnesses? And your just personal opinion. What do you like?
Gabe Howard: Obviously, I wish that we could label them 100% correctly the first time, but I like your spectrum idea that, OK, you are going to fall somewhere on here. One, I think it opens the door to have more friends. I know that’s a weird thing to say. Right. But there’s more people that will have it in common. And I don’t know if spectrum is the right word. Right. You know, let’s take cancer. People with cancer, they have this bond. It doesn’t matter if you had breast cancer, lung cancer or testicular cancer. If you are in the room with somebody else who has had a completely different type of cancer than you, there becomes this almost like, hey, I fought cancer. Hey, me too. And while it may have been on different areas of the body, they understood it. You can see how that developed because we all understand the difference between lungs and breasts and and on and on and on. But how do we do that for mental health? How do we do that for the brain? I would like in fact, I would love that everybody recognizes that everybody has mental health, some people have mental illness, and we’re all on some sort of spectrum. Most people have good mental health the majority of the time. But even people who have good mental health can have bad mental health days, for example, grief. Nobody’s going to be at their best the day after a loved one dies, and people go through changes as they get older. I would like to see some sort of acknowledgment that just because Rachel Star Withers has schizophrenia and Gabe Howard has bipolar disorder and Lisa Kiner, our long suffering producer and content editor of this podcast, has major depression that we’re all on the same spectrum, we’re all on the same journey. I have no idea what to label that, but I wish that people at the very least would start thinking about it that way so that we can find those things that we have in common, work together, and as you said, Rachel, not feel so desperately alone.
Rachel Star Withers: I really love that thought that if you were to share oh, I have schizophrenia, the response being, oh, you? Wow, you know, I have depression and there are almost being like an automatic connection versus, oh, you have schizophrenia? Weird,
Gabe Howard: Yeah,
Rachel Star Withers: Eww, that has a Z in it. Oh, but but no, I think it’s a beautiful thought that it not being that scary. If someone says they have bipolar not being like, oh my gosh. And like thinking not I don’t want to say the worst in a bad way, but thinking like, OK, you’re someone who’s constantly having a manic episode, you know, only seeing the symptoms as opposed to seeing the overall like, oh, I’ve experienced a piece of this. I can understand a small piece and like that connects us. I don’t know. That was just really beautiful. What you shared, Gabe. I like that. I liked it.
Gabe Howard: Thank you so much, Rachel. I genuinely believe that it would lead to better outcomes as well, so hopefully someday we will get there. And Gabe Howard, the mental health advocate, is extraordinarily hopeful. Now, we’ll be right back after a word from our sponsor.
Announcer: Interested in learning about psychology and mental health from experts in the field? Give a listen to the Psych Central Podcast, hosted by Gabe Howard. Visit PsychCentral.com/Show or subscribe to The Psych Central Podcast on your favorite podcast player.
Rachel Star Withers: And we’re back talking about the differences in schizoaffective disorder and schizophrenia.
Gabe Howard: We have been talking about how we have the lived experience and the patient perspective, this whole episode. So it stands to reason at some point we should bring along a doctor. I am very excited to introduce Dr. Michelle Maust from MindPath Care Centers. Recently, Rachel got to sit down with her and talk to her all about schizoaffective disorder. So without further ado, here is that interview.
Rachel Star Withers: We’re excited to be speaking with Dr. Michelle Maust from the MindPath Care Centers, and she is a practicing psychiatrist with them. Thank you so much for being with us here today, Dr. Maust.
Dr. Michelle Maust: Absolutely, I’m happy to be here.
Rachel Star Withers: You have a very interesting background that I did want to hit, that you used to be a doctor in the United States Army.
Dr. Michelle Maust: Correct.
Rachel Star Withers: Yes. Thank you so much for serving. How is private practice different from serving with the military?
Dr. Michelle Maust: I really valued my time in the Army, the army trained me in residency in psychiatry, and then I served at Fort Bragg as a general psychiatrist. I’d say the biggest difference? There’s a simplification of insurance
Rachel Star Withers: Sure,
Dr. Michelle Maust: Issues in the army, which is very nice,
Rachel Star Withers: Yeah, I’d imagine that.
Dr. Michelle Maust: Yeah, compared to the private sector. But there are some very real challenges in the Army in terms of deployment preparedness that can make practicing psychiatry difficult for individuals who also need to be able to go downrange into war. But honestly speaking, it’s pretty similar. People everywhere in whatever population you look at deal with psychiatric issues.
Rachel Star Withers: Very cool and again, thank you so much for serving. Today’s episode is discussing schizoaffective disorder. I have schizophrenia, I’ve definitely heard the term brought up so many times throughout my, I’m going to say not my career of having schizophrenia, but my life of having been diagnosed with schizophrenia. And it can get really confusing. So can you, in layman’s terms, explain to us what exactly is schizoaffective disorder?
Dr. Michelle Maust: Schizoaffective is a serious mental illness that’s a combination of a psychotic disorder and a mood disorder, but it can certainly get more complex than that. I think most people are familiar with mood disorders like depression or major depressive disorder and bipolar disorder. Mania can be the hallmark of bipolar disorder. And mania is this persistent, elevated energy state. We sometimes call it like the brain is on fire where people can be really fast, talking fast, really decreased need for sleep, not sleeping, really impulsive. That’s the picture of mania. And it can look very much like psychosis. Mania actually often has psychotic features in it. In my world in psychiatry we’re just trying to describe in diagnostic terms are these different presentations of illness, mood symptoms like depression and mania and psychotic symptoms like hallucinations and delusions. And sometimes these symptoms present in a very combined way. And when that happens, that’s when we end up calling it schizoaffective disorder.
Rachel Star Withers: Now, how does schizoaffective disorder differ from just schizophrenia?
Dr. Michelle Maust: Great question, the schizoaffective disorder has a more prominent mood component, as in it has more depression or more manic symptoms than the illness of schizophrenia. Often schizophrenia presents in young people, men or women, but often in young men, even as young as 18 years old sometimes where pretty suddenly they develop psychotic symptoms and often end up needing to be in the hospital. That’s what we call a first break psychosis. And it can look very strange, this scary presentation with someone who is often paranoid and thinking people are out to get him, very disorganized. Often people even lose their ability to talk it’s like they’re less coherent. So often when someone presents to the hospital with the first break psychosis, that often leads to a diagnosis of schizophrenia. However, not all psychosis is schizophrenia. Psychosis can be from a lot of different things, including drugs, substances, other illnesses, dementia. So we always have to make sure to rule those things out or look for other medical illnesses that could be causing the symptoms. But when we’ve ruled all those things out and we’re left with a first break psychosis, we often end up diagnosing schizophreniform or schizophrenia, which is a psychotic disorder. This disorder is different. It’s a different diagnosis from schizoaffective. But to be honest, sometimes we’re not one hundred percent sure when we first see a patient because that person who presents with psychotic symptoms could later then have an episode that looks like mania, in which case we would then call it a schizoaffective disorder, where you have the combination of the psychotic episode and the mood symptoms or the manic episode.
Rachel Star Withers: Ok.
Dr. Michelle Maust: Schizophrenia doesn’t have as much of that mood component when people present in a manic episode and then later on they also have mood symptoms. That’s when we call it schizoaffective disorder. We definitely have diagnostic criteria that kind of stipulate what makes schizophrenia and what makes schizoaffective disorder. But to be honest, sometimes it’s hard to tell the difference, especially when we’re first seeing a patient. Sometimes it takes a while for that illness to present itself, but it often does look different. There does seem to be a significant difference between schizophrenia and schizoaffective disorder and how it looks. Let me just give an example. In schizophrenia, it’s often a lot of thought disorganization, difficulty putting thoughts together and speaking and engaging along with those psychotic symptoms. But in the schizoaffective disorder, with a bipolar type, it can look like mania, wild and fast and strange and have this kind of flare component. Like I remember a patient with schizoaffective in his manic episode comes into the emergency room, bringing flowers to share with everyone. So this very loud, grandiose, pleasant presentation can feel very different because it has that manic or mood component compared to schizophrenia.
Rachel Star Withers: Very interesting. Now, can someone have a diagnosis of schizophrenia in a diagnosis of depression and that not be classified as schizoaffective disorder?
Dr. Michelle Maust: Yes, let’s get into the weeds a little bit. If someone has they’ve developed a psychotic episode and they’ve been evaluated and they are diagnosed with schizophrenia, they can undergo treatment and then a psychotic episode resolves and they’re maintaining care and then they develop a depressive episode. In that case, the patient with schizophrenia could also have a diagnosis of a major depressive disorder. We call it comorbid when those two diagnoses go together, that would be different from schizoaffective disorder in that in schizoaffective disorder, the patient has psychotic symptoms. Whether she’s in the mood episode or not. These details are sometimes difficult to tease out, which is why no matter what the diagnosis, it’s so important for anyone, especially with psychotic symptoms, to be getting care and having regular follow up with a psychiatric provider.
Rachel Star Withers: Many of schizophrenia’s symptoms can mirror those of depression, like flat affect, decreased feelings of pleasure, diminished emotional expression. How would you differentiate those from schizoaffective disorder or do they all just fall in together?
Dr. Michelle Maust: When I see a patient, I’m taking the whole picture, so I’m looking at what’s bothersome to them and what I’m seeing. I’m always looking for all of the symptoms, but I’m also I’m looking for the most prominent symptoms. When someone is depressed, that person feels depressed, looks depressed, has some very physical features of depression. If depression is like the most prominent thing, then that person, I would say, is in a depressed episode. If the patient has depression plus psychotic symptoms together, like having hallucinations in a depressed episode, then that can be a schizoaffective disorder. It could also be what we call a major depressive disorder with psychotic features. But if those psychotic symptoms are a prominent part of that illness, that’s when we typically call it schizoaffective disorder.
Rachel Star Withers: Schizophrenia and schizoaffective disorder, they’ve both been reclassified multiple times. When I first got diagnosed, I was diagnosed as a paranoid schizophrenic with dysthymia. I know it’s like they don’t use the paranoid parts anymore. And you almost never
Dr. Michelle Maust: Right.
Rachel Star Withers: Hear dysthymia. Not even over the past 50 years, we’re talking over the past like 15. How can like these reclassifications and changing of terms, how does that affect different patients’ treatment or does it seem to affect it?
Dr. Michelle Maust: Good question. There are definitely revisions of our guidelines and how we understand psychiatry. It’s always a good reminder that in my profession, in psychiatry, we’re trying to understand individuals with very unique presentations of illness. So even though we recognize these patterns of illness, psychotic symptoms and mood symptoms and mania, it can come out and look so different in individuals. It takes some time to understand it. And that’s why I think my profession is always revising it and using these different terms to describe it. But here’s the good news. Whether the diagnosis is schizophrenia or schizoaffective disorder, often we use the same category of medication. Antipsychotic medications are the treatment for psychotic symptoms. So we often use antipsychotics to treat schizophrenia and schizoaffective disorder.
Rachel Star Withers: So the treatment then, regardless whether it’s schizophrenia or schizoaffective disorder, it’s going to be in the same area.
Dr. Michelle Maust: Our treatment converges onto this class of medications that we call antipsychotics, we use antipsychotics for people with schizophrenia and people with schizoaffective disorder. There’s another class of medications we use sometimes called mood stabilizers that are more specific to treating bipolar disorder or schizoaffective disorder because they help stabilize that mood component of the illness. The good news is antipsychotics are also a mood stabilizing medication. So we have a number of different antipsychotic medication options that can treat people with schizophrenia and people with bipolar and schizoaffective disorder. We also have other mood stabilizers, classic mood stabilizers that are separate from antipsychotics that would be used in a schizoaffective or bipolar disorder and not necessarily used in schizophrenia. But we have a number of different treatment options.
Rachel Star Withers: So, Dr. Maust, what if you are a friend or loved one and you see someone starting to exhibit these psychotic episodes, what do you suggest that they do?
Dr. Michelle Maust: Yes, friends and family are so critical to helping people get care, usually because when people are in the throes of a psychotic episode or a manic episode, they’re psychotic, they lose touch with reality, and they don’t have a good sense of how sick they are. When you’re seeing symptoms or when you’re concerned about someone, that person’s not even making sense or is not even sleeping at all. Those are reasons to get help. The National Suicide Hotline, (800) 273-TALK, that could be used for any kind of crisis. It doesn’t have to be thoughts of suicide. If you’re ever seeing someone not making sense, acting very bizarre or psychotic, get that person some help because we have treatments. We can help people with psychotic disorders live meaningful lives.
Rachel Star Withers: If someone is experiencing a psychotic disorder and they’re having issues with getting help or not getting adequate care, do you have any suggestions for that?
Dr. Michelle Maust: Yes, first help the patient get to care, whether that’s a hospital or clinic, and start developing a relationship with a provider and to get medication treatment. There are so many therapeutic options that can help, but really for psychotic disorders, they need treatment with usually antipsychotic medication. Antipsychotic medications can help people live their lives and continue on beyond their mental illness. Antipsychotic medication come in a lot of forms, including injectable medications. Sometimes part of someone’s illnesses that they don’t want to take medications or they think they’re being poisoned if they’re taking medication, that can happen with psychotic symptoms. We have a solution that is known to help decrease hospitalization in people with psychotic disorders. We can provide antipsychotics through an injection that lasts a whole month. So rather than having to take pills, we can give a shot. That medication will last monthly or sometimes even longer, depending on the medication. So those are wonderful treatment options to get people to long term health care, even with serious mental illness. And there are wonderful resources out there. The FMIAdviser.org, an organization from the American Psychiatric Association to share information for people with psychotic disorders and their families. Of course, there’s NAMI, the National Alliance on Mental Illness, NAMI.org. And, I’ll tout my practice, MindPathCare.com. We have a growing practice with so many providers who are here to help.
Rachel Star Withers: Dr. Maust, when you diagnose someone with schizoaffective disorder, what are the next steps that person should take?
Dr. Michelle Maust: Getting care. So I can’t emphasize it enough and care can come in a lot of different forms, sometimes it’s in the hospital, but usually we’re able to help people stay out of the hospital, live their lives with long term care. I guess what I’m saying is to continue that care with a psychiatric provider that you trust so that you can manage your symptoms over time because psychotic disorders do not go away, but we can treat them. And getting yourself to regular care is the way that we best know how to do that. And also the basics that help for everyone, psychotic disorder or not. Getting enough sleep, ways to de-stress, because we know that stress and sleep deprivation can worsen mood and psychotic disorders, all of those basic sleep, diet, exercise, regular activity, engaging hobbies, all of those things are helpful for everyone, but especially helpful when people are dealing with a serious mental illness.
Rachel Star Withers: Yes, agreed. Thank you so much, Dr. Maust, for speaking with us today and really enlightening us on the differences in schizoaffective disorder, schizophrenia, bipolar, depression, all those little nuances that could be very hard for the nonmedical professionals out there.
Dr. Michelle Maust: Yes, thank you so much.
Gabe Howard: Rachel, cool interview, as always. Did Dr. Maust help you understand schizoaffective disorder better? Did she clarify anything for you? Do you feel that you have a better understanding of the differences between schizoaffective and schizophrenia now that you had the opportunity to speak with her?
Rachel Star Withers: Yes, and, you know, I’m like ready to go figure out where her office is, like when she was talking, I kind of wanted to be like, I need to see if my insurance covers her. I really liked that she sounded not knowledgeable in the fact like she was a super book smart. But she to me came off as knowledgeable in that she’s worked with a lot of different people. I did think that her military bacqkground was important because she’s treated people that I guess like normal doctors wouldn’t see as often. And it was something about her that just came off as very knowledgeable to me. This whole podcast we were talking how confusing schizoaffective disorder is. And she was just easy to talk to and very confident in how she spoke. Which was the opposite, I felt, of trying to learn all of this stuff about schizoaffective. She’s just I think it comes with treating different people and different disorders and then different things that people have experienced.
Gabe Howard: It was very evident that her level of knowledge was significantly higher than ours, and that’s a good thing, right?
Rachel Star Withers: Yes, yes.
Gabe Howard: Yeah, she sort of took some of the scary away for me is probably the best way that I could put it. I really appreciated her calm demeanor when it came to schizoaffective disorder because, like you said, it’s scary. It has a Z in it.
Rachel Star Withers: And it’s true, all of this is, it’s scary. As someone going through schizophrenia, schizoaffective disorder, bipolar depression, anything, all of this can be very, very scary. I think any sort of health situation is. And the more unknown the health situation is, the scarier. So it’s so awesome when you do have someone who can kind of calmly be like, OK, let’s look at the facts, let’s see what’s going on. Let’s sit down and talk. Overall, the biggest theme here is don’t get caught on the words. Don’t be freaking out. Oh, gosh, they’ve misdiagnosed me with this, this or this. A lot of this is self reporting. So you do have to be honest with yourself and others. I always say it, and I know people probably get annoyed by how much, you know, but a lot of this is your own responsibility. And I’ll be the first to tell you, Gabe, I have been really lazy this past month about tracking my symptoms. And part of it was because I started a new treatment and it made me tired. And as I’m talking, I’m like, I’m really bad right now that I haven’t been tracking my symptoms. So if you were to say, Rachel, have you been episodic? I’d be like, I don’t know. I don’t know.
Gabe Howard: It’s easy to get complacent,
Rachel Star Withers: Yeah. Oh, I have.
Gabe Howard: It’s important to understand that
Rachel Star Withers: Yes.
Gabe Howard: You are human. You’re right, Rachel, it is your responsibility, but you’re also human, mental illness or not. People during the holidays, during global pandemics, they put stuff off, they get complacent, they forget things. Don’t beat yourself up. Just get back on the right track, acknowledge it, pick yourself up, dust yourself off and get right back to what you need to do and get those good outcomes.
Rachel Star Withers: It’s all about getting help. That’s always I say the bravest thing is whenever you see that there’s something wrong, you’re actively changing it. Whether you’re worried about having issues with schizophrenia, schizoaffective disorder or bipolar depression, the point is to get help, to be honest with yourself and to be honest with the doctors and counselors and all the other wonderful people you have on your side, on your team. You all have the same goal, that’s to get better. Thank you so much for listening to this episode of Inside Schizophrenia. Please, like, share, subscribe and rate our podcast. We will see you next time here on Inside Schizophrenia.
Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail talkback@PsychCentral.com. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.