Schizoaffective disorder can involve symptoms of depression, mania, or psychosis.
Schizoaffective disorder is a mental health condition that involves episodes of combined mood and schizophrenia symptoms.
During a period of depression, mania, or both, you could also experience:
- disorganized speech
- other symptoms of psychosis
The combination of mood symptoms and symptoms of psychosis can make the condition difficult to diagnose. In fact,
That’s because both bipolar disorder and depression can involve symptoms of psychosis, while people living with schizophrenia often experience depression and symptoms that resemble mania.
Without treatment, this condition can be difficult to live with. Severe symptoms can affect daily life, cause emotional distress, and prompt judgment and stigma from others. But treatment and support can make a big difference.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes schizoaffective disorder as a schizophrenia spectrum disorder.
The condition involves symptoms of mania or depression (sometimes both) as well as symptoms of psychosis, which could be described as a disconnect or break from reality.
Schizoaffective disorder is less common than schizophrenia. Current estimates suggest it affects around
Like other schizophrenia spectrum disorders, this condition most often shows up in early adulthood. Symptoms generally begin in the mid-20s, but they can appear in the teen years or middle age.
Mental health professionals might not connect your symptoms to schizoaffective disorder right away. Many people get a diagnosis of a different condition, such as bipolar disorder, depression, or another condition involving psychosis, before symptoms begin to follow a clearer pattern.
The symptoms of schizoaffective disorder can seem somewhat complex.
In basic terms, the condition involves episodes that meet diagnostic criteria for an episode of mania or depression and criteria for schizophrenia.
You might experience the following symptoms.
Symptoms of mania
Mania symptoms typically include:
- unusually high energy
- decreased need for sleep
- a high or euphoric mood
- increased talkativeness
- a tendency to get distracted
- racing thoughts or conversation that moves rapidly from one topic to another
- inflated self-confidence or self-esteem
- impulsive behavior or increased risk-taking
- sudden dedication to projects — often several at once — at home, school, or work
Symptoms of depression
People experience depression in very different ways, but these are the common symptoms:
- persistent feelings of sadness and hopelessness
- a sense of emptiness or emotional numbness
- decreased energy
- fatigue, insomnia, and other sleep disturbances
- difficulty concentrating and remembering things
- unusual feelings of physical or mental slowness
- anger and irritability
- a lack of interest in regular habits and routines
- anhedonia, or difficulty finding pleasure in things you usually enjoy
- feelings of guilt and worthlessness
- thoughts of death or dying
Some depression symptoms, including anhedonia and irritability, can also appear with schizophrenia. But diagnostic criteria for schizoaffective disorder require a persistent low mood during an episode of depression.
Symptoms of schizophrenia
Schizophrenia can involve many different symptoms, including:
- paranoia (extreme suspicion of others)
- trouble concentrating
- disorganized speech patterns, including rapid changes in topic or unrelated words and phrases strung together
- difficulty learning and remembering new information
- physical agitation, restlessness, or unintentional movements
- difficulty expressing emotions
- loss of pleasure and interest in everyday activities or life in general
- social withdrawal and self-isolation
- insomnia and other sleep problems
You can explore schizophrenia symptoms in more detail here.
When you have a combination of the symptoms above, mental health professionals will:
- consider whether you’ve had delusions and hallucinations for at least 2 weeks without mania or depression
- consider whether your mood symptoms have been present for most, but maybe not all, of the time you’ve had symptoms
- rule out other health conditions
- make sure you aren’t taking any medications or other substances that could cause similar symptoms
Experts have identified two subtypes of schizoaffective disorder.
With this subtype, you’ll experience mood episodes that involve symptoms of mania, such as:
- racing thoughts
- elevated energy
- increased activity
You may also have episodes of depression.
With this subtype, your mood episodes will involve only symptoms of depression, such as:
- a persistent low mood
- emotional numbness
- less interest in your regular activities
You won’t have any symptoms of mania.
Schizoaffective disorder doesn’t show up in the same way for everyone, but it often has a big impact on day-to-day life.
You might start to have hallucinations or delusions long before you notice mania or depression.
These experiences will be very real to you. They can make it difficult to focus on your surroundings. You might feel as if you’re dreaming or have trouble recognizing what’s real and what isn’t.
- The things you see and hear might seem familiar and comforting: a deceased relative, a friendly animal, or soft music.
- Hallucinations can also feel frightening, confusing, or annoying: sounds of fighting, someone following you, or whispers that say unkind things or tell you to hurt yourself or someone else.
- Delusions are false beliefs. You might feel convinced that someone is watching you and trying to control you, that you’re famous, or that your friends are trying to harm you.
Symptoms can also affect the way your brain learns, processes, and uses information. You might suddenly find it harder to concentrate or remember things and start to struggle at work or school. Your thoughts might race or feel difficult to grasp.
Before or during this period of psychosis, you’ll also start to experience mood symptoms.
With the depressive type, you might pull back from friends and family or spend far more time than usual sleeping. It might be difficult to muster any enthusiasm for the things you usually enjoy.
With the bipolar type, you might feel energized and optimistic, make a lot of plans, or make impulsive decisions, such as taking a loved one’s car for a drive when you don’t have a license, buying an outfit that’s out of your budget, or lashing out in rage at your boss.
Mood symptoms might linger for as long as you have symptoms of psychosis. They could also taper off before the symptoms of psychosis pass. You may have some times when you don’t have any symptoms at all.
You can learn more about living with schizoaffective disorder here.
A number of factors may play a part, including:
- imbalances of the important brain chemicals dopamine, norepinephrine, and serotonin
- differences in the hippocampus and white matter in the brain
- childhood trauma or abuse
- genetics (family history)
You have a higher chance of developing schizoaffective disorder if a family member has schizophrenia, bipolar disorder, or schizoaffective disorder.
Some overlap exists between bipolar disorder and schizophrenia. These similarities have led some experts to
Schizoaffective disorder is often misdiagnosed as depression, bipolar disorder, or schizophrenia, since it can involve symptoms of each of these conditions.
The right diagnosis is often key to managing your symptoms, since a correct diagnosis can help you get treatment that’s more likely to help.
It’s a good idea to tell someone you trust about your symptoms as soon as you start noticing them. If tracking symptoms on your own is difficult, a sibling, parent, partner, or friend can help you write them down and go with you to your therapy appointment.
If possible, it’s a good idea to reach out to a mental health professional who specializes in treating schizophrenia and related conditions. They’ll be better able to recognize the pattern of symptoms.
You can start by telling your doctor about the symptoms you’ve noticed. Even changes that seem minor — like a sudden euphoric mood, emotional numbness, or persistent hopelessness — could help them tell the difference between schizoaffective disorder and other conditions.
It’s not always easy to open up about things like unsettling hallucinations, but remember: Mental health professionals should offer compassion, not judgment. They know you can’t control or prevent these hallucinations or any other symptom you experience.
Before diagnosing schizoaffective disorder, your doctor will first rule out other conditions, such as:
- Major depressive disorder with psychotic features. With this condition, you typically won’t have any symptoms of psychosis unless you’re also having an episode of depression.
- Bipolar disorder. You might experience psychosis during a mood episode, but you generally won’t have these symptoms on their own.
- Schizophrenia. This condition can involve changes in mood, but any mood symptoms won’t meet criteria for an episode of depression or mania.
- Post-traumatic stress disorder (PTSD). Flashbacks in PTSD might seem like hallucinations, while fear and anxiety might resemble paranoia. But PTSD symptoms usually relate to a specific trauma.
- Substance-induced psychosis. Some substances, including certain prescription medications,
alcohol, and cannabis, can trigger symptoms of psychosis.
If you also experience mood symptoms, your doctor will consider any substances you’re taking before making a diagnosis of schizoaffective disorder.
Although schizoaffective disorder can’t be cured, a combination of medication and therapy can go a long way toward reducing your symptoms.
Your care team might involve:
- a psychiatrist or other mental health professional who can prescribe medication
- a therapist or other mental health professional who provides talk therapy and other support
- a school counselor or workplace advocate
A therapist might also recommend:
- group therapy
- social skills training
- family and relationship counseling
A few different medications can help manage mood symptoms and psychosis. Your psychiatrist may prescribe one or more of the following, depending on your symptoms:
Not every medication works for everyone, so make sure to tell your psychiatrist about any unwanted side effects. It’s important to keep taking the medication until they prescribe something new or tell you it’s OK to stop.
Sudden mood changes can be overwhelming enough. Psychosis can affect your perception of reality, adding to your distress.
You might keep your symptoms to yourself, worrying that stigma surrounding hallucinations, delusions, and other symptoms of psychosis could lead others to judge you.
While a diagnosis of schizoaffective disorder may seem frightening, getting a diagnosis is often the only way to start managing symptoms.
Connecting with a compassionate mental health professional can make it possible for you to get relief from symptoms, learn helpful coping strategies, and get back to living the life you want.
You can start your journey toward recovery with these resources:
- Visit the American Psychological Association to find a psychologist.
- Visit the American Psychiatric Association to find a psychiatrist.
- Visit the Substance Abuse and Mental Health Services Administration to find mental health professionals in your area.
- Visit the National Alliance on Mental Illness for tips on finding the right mental health professional.