POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

SCHIZOAFFECTIVE DISORDER

Presented to the Faculty of the Graduate School

Polytechnic University of the Philippines
Sta. Mesa, Manila

In Partial Fulfillment of the Requirements in Clinical Psychology

Master in Psychology (Clinical Psychology)

Submitted by

Karen Gail P. Comia

(MP-CP)

Submitted to

Dr. Nenita F. Buan

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

SCHIZOAFFECTIVE DISORDER

Case Study:

Mr. C, a 28-year-old accountant, was brought to the emergency department by the

police in handcuffs. He was disheveled, and shouted and struggled with the police
officers. It was apparent that he was hearing voices because he would respond to them
with shouts such as, “Shut up! I told you I won’t do it!” However, when confronted about
the voices, he denied hearing anything. Mr. C had a hypervigilant stare and jumped at
the slightest noise. He stated that he must run away quickly because he knew he would
be killed shortly otherwise.
Mr. C was functioning well until 2 months before hospitalization. He was an accountant
at a prestigious company and had close friends and a live-in girlfriend. Most people who
knew him would describe him as friendly, but he was occasionally quarrelsome. When
his girlfriend suddenly broke of the relationship and moved out of their apartment, Mr. C
was distressed. However, he was convinced that he could win her back, so he began to
“accidentally” run into her at her job or her new apartment with flowers and various gifts.
When she strongly told him that she wanted nothing more to do with him and requested
that he leave her alone, Mr. C was convinced that she wanted him dead. He became so
preoccupied with this notion that his work began to suffer. Out of fear for his life, Mr. C
took of from work frequently, and when he did report to work, he was often tardy and did
subpar work, making many errors. His supervisor confronted Mr. C about his behavior,
threatening termination if it continued. Mr. C was embarrassed and resented his
supervisor for the confrontation. He believed that his ex-girlfriend had hired the
supervisor to kill him. His beliefs were confirmed by a voice that would mock him. The
voice told him time and again that he should quit his job, relocate to another city, and
forget about his ex-girlfriend, but Mr. C refused, believing it would give them “more
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
satisfaction than they deserved.” He continued working, albeit cautiously, all the while
fearing for his life.
Through it all, Mr. C believed himself to be the lone victim. He would awake abruptly at
night from nightmares but would be able to fall right back to sleep. He had not lost any
weight and had no other vegetative symptoms. His affect alternated between rage and
terror. His mind was unusually alert and active, but he was not otherwise hyperactive,
excessively energetic, or expansive. He did not display any formal thought disorder.
Mr. C was hospitalized and treated with antipsychotic medication. His symptoms
remitted after several weeks of treatment, and he was well and able to return to work
shortly after discharge.

Schizoaffective Disorder:
Schizoaffective disorder has features of both schizophrenia and mood disorders.
In current diagnostic systems, patients can receive the diagnosis of schizoaffective
disorder if they fit into one of the following six categories: (1) patients with schizophrenia
who have mood symptoms, (2) patients with mood disorder who have symptoms of
schizophrenia, (3) patients with both mood disorder and schizophrenia, (4) patients with
a third psychosis unrelated to schizophrenia and mood disorder, (5) patients whose
disorder is on a continuum between schizophrenia and mood disorder, and (6) patients
with some combination of the above.
Diagnostic Criteria of Schizoaffective Disorder
A. An uninterrupted period of illness during which there is a major mood episode
(major depressive or manic) concurrent with Criterion A of schizophrenia. Note:
The major depressive episode must include Criterion A1 : Depressed mood.
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood
episode (depressive or manic) during the lifetime duration of the illness.
C. Symptoms that meet criteria for a major mood episode are present for the
majority of the total duration of the active and residual portions of the illness.
D. The disturbance is not attributable to the effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition.
Specify whether:
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
Bipolar type: This subtype applies if a manic episode is part of the presentation.
Major depressive episodes may also occur.
Depressive type: This subtype applies if only major depressive episodes are part of
the presentation.
Specify if:
With catatonia
Specify if:
The following course specifiers are only to be used after a 1 -year duration of the
disorder and if they are not in contradiction to the diagnostic course criteria.
First episode, currently in acute episode: First manifestation of the disorder meeting
the defining diagnostic symptom and time criteria. An acute episode is a time period in
which the symptom criteria are fulfilled.
First episode, currently in partial remission: Partial remission is a time period during
which an improvement after a previous episode is maintained and in which the defining
criteria of the disorder are only partially fulfilled.
First episode, currently in full remission: Full remission is a period of time after a
previous episode during which no disorder-specific symptoms are present.
Multiple episodes, currently in acute episode: Multiple episodes may be determined
after a minimum of two episodes (i.e., after a first episode, a remission and a minimum
of one relapse).
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder
are remaining for the majority of the illness course, with subthreshold symptom periods
being very brief relative to the overall course.
Unspecified
Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of
psychosis, including delusions, hallucinations, disorganized speech, abnormal
psychomotor behavior, and negative symptoms. Each of these symptoms may be rated
for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
(not present) to 4 (present and severe). (See Clinician-Rated Dimensions of Psychosis
Symptom Severity in the chapter “Assessment Measures.”) Note: Diagnosis of
schizoaffective disorder can be made without using this severity specifier.

ICD 10

There must be prominent depression, accompanied by at least two characteristic

depressive symptoms or associated behavioural abnormalities as listed for depressive
episode (F32.-); within the same episode, at least one and preferably two typically
schizophrenic symptoms (as specified for schizophrenia (F20.-), diagnostic guidelines
(a)-(d)) should be clearly present.
This category should be used both for a single schizoaffective episode, depressive type,
and for a recurrent disorder in which the majority of episodes are schizoaffective,
depressive type.
Includes: schizoaffective psychosis, depressive type
schizophreniform psychosis, depressive type

F25.2 Schizoaffective disorder, mixed type

Disorders in which symptoms of schizophrenia (F20.-) coexist with those of a mixed
bipolar affective disorder (F31.6) should be coded here.
Includes: cyclic schizophrenia
mixed schizophrenic and affective psychosis
F25.8 Other schizoaffective disorders
F25.9 Schizoaffective disorder, unspecified
Includes: schizoaffective psychosis NOS

Prevalence:

Schizoaffective disorder appears to be about one-third as common as

schizophrenia. Lifetime prevalence of schizoaffective disorder is estimated to be 0.3%.
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
The incidence of schizoaffective disorder is higher in females than in males, mainly due
to an increased incidence of the depressive type among females

Risk and Prognostic Features:

Genetic and physiological - Among individuals with schizophrenia, there may be an

increased risk for schizoaffective disorder in first-degree relatives. The risk for
schizoaffective disorder may be increased among individuals who have a first-degree
relative with schizophrenia, bipolar disorder, or schizoaffective disorder

Theories of Personality

Psychoanalytic Theory - Jacob Kasanin postulated that schizoaffective dpsychosis was

caused by “emotional conflicts” of a “mainly sexual nature”.

Testing:

Self-test for Schizoaffective Disorder

Minnesota Multiphasic Personality Inventory
House Tree Person Test
Rorschach Inkblot Test
Thematic Apperception Test
Bender Visual Motor Gestalt Test
Draw a Person Test

Psychotherapy:

Patients benefit from a combination of family therapy, social skills training, and
cognitive rehabilitation. Because the psychiatric field has had difficulty deciding on the
exact diagnosis and prognosis of schizoaffective disorder, this uncertainty must be
explained to the patient. The range of symptoms can be vast because patients contend
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
with both ongoing psychosis and varying mood states. It can be very difficult for family
members to keep up with the changing nature and needs of these patients.

Psychotherapy and counseling.- Building a trusting relationship in therapy can help

people with schizoaffective disorder better understand their condition and feel hopeful
about their future. Effective sessions focus on real-life plans, problems and
relationships. New skills and behaviors specific to settings, such as the home or
workplace, also may be introduced.

Cognitive behavioral therapy - CBT helps change the negative thinking and behavior
associated with feelings of depression. The goal of this therapy is to recognize negative
thoughts and to teach coping strategies. With conditions like schizoaffective disorder
that have symptoms of psychosis, additional cognitive therapy is added to basic CBT
(CBTp). CBTp helps people develop coping strategies for persistent symptoms that do
not respond to medicine.

Family or group therapy- Treatment can be more effective when people with
schizoaffective disorder are able to discuss their real-life problems with others.
Supportive group settings can also help decrease social isolation and provide a reality
check during periods of psychosis.

References:

Sadock, Benjamin James, et. Al., Kaplan & Sadock’s Synopsis of Psychiatry
Behavioral Sciences/Clinical Psychiatry, Eleventh Edition. Wolters Kluwer. Two Commerce
Square, 2001 Market Street, Philadelphia, PA 19103. 2015
Groth Marnat, Gary. Handbook of Psychological Assessment, Fourth Edition. John Wiley &
Sons, Inc, Hoboken New Jersey. 2003
Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition. American Psychiatric
Association
The ICD 10 Classification of Mental and Behavioral Disorders, World Health Organization.
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

http://www.mayoclinic.org/diseases-conditions/schizoaffective-
disorder/basics/definition/con-20029221
http://www.nami.org/Learn-More/Mental-Health-Conditions/Schizoaffective-
Disorder/Treatment#sthash.KHx3QKL8.dpuf
https://www.blueskyrecovery.com/selftest.aspx?CatID=22

https://en.wikipedia.org/wiki/Schizoaffective_disorder

http://www.ukessays.com/essays/psychology/background-associated-
withschizoaffective-disorder-psychology-essay.php