8 differences between schizoaffective disorder and schizophrenia

Schizoaffective disorder and schizophrenia are two mental disorders that can be found in the category of psychotic disorders. Psychotic disorders include two typical symptoms: delusions and hallucinations (although there are more of them).

These two disorders, although they have some similarities, are quite different. But … What are the differences between schizoaffective disorder and schizophrenia? In this article we will get to know them.

    Schizoaffective Disorder and Schizophrenia: What Are They?

    Before we explore the differences between schizoaffective disorder and schizophrenia, let’s take a look at what each of these mental disorders is.

    1. Schizoaffective disorder

    Schizoaffective disorder belongs to the group of psychotic disorders. In other words, it is included in this category alongside others such as schizophrenia or delusional disorder. Its prevalence is 0.3% of the population, According to the DSM-5 (Diagnostic Manual of Mental Disorders).

    But what does it consist of? The DSM-5 diagnostic criteria for schizoaffective disorder include: that criterion A for schizophrenia is met (delusions, hallucinations, disorganized language … for at least one month) and an uninterrupted period of illness during of which a major depressive episode (which necessarily includes depressed mood) or a manic episode has already occurred.

    In other words, in this case psychotic symptoms are combined with mood symptoms. In addition, it is necessary that for at least 2 weeks no significant emotional symptom has appeared except delusions or hallucinations.

    This disorder is somewhat controversial, as some authors consider it an independent disorder of schizophrenia, others consider it a variant of it, and others as a variant of mood disorders. Finally, others believe that it is a transient state between schizophrenia and mood disorders.

    2. Schizophrenia

    Schizophrenia is the “quintessential” psychotic disorder. About 0.3 and 0.7% of the world’s population suffers from schizophrenia, according to the latest edition of DSM-5. It is a very disabling mental disorder, although there is inter-individual variability, and with psychological and pharmacological treatment the disease can be brought under control.

    Schizophrenia includes a number of symptoms such as hallucinations, delusions, disorganized thinking and language, cognitive impairment, abulias, depressive symptoms, flattened condition, etc. Hallucinations and delusions are classic psychotic symptoms, Which may also appear in other disorders of the psychotic spectrum beyond schizophrenia.

    More specifically, the DSM-5 diagnostic criteria for schizophrenia include: characteristic symptoms such as those we have mentioned (hallucinations, delusions …) which must last at least 1 month, in addition to a socio-dysfunction professional life and the presence of continuous signs of deterioration that must last at least 6 months (this includes the prodromal and residual period of the disease).

      8 Differences between schizoaffective disorder and schizophrenia

      As we have seen, schizoaffective disorder and schizophrenia are two independent disorders. Its fundamental difference is that in schizoaffective disorder, in addition to meeting criterion A for schizophrenia, the criteria for a major depressive episode or a bipolar depressive episode are met.

      On top of that, there are more differences between the two. So, without further ado, let’s take a look at the 8 differences between schizoaffective disorder and schizophrenia:

      1. Duration criteria

      The first of the differences between schizoaffective disorder and schizophrenia concerns the criteria of duration.

      The diagnostic criteria for schizophrenia require that they have emerged characteristic symptoms such as delusions, hallucinations, disorganized language, etc., For at least 1 month (or less if symptoms have been successfully treated). In addition, there must be continuous signs of the deterioration for at least 6 months.

      In contrast, in schizoaffective disorder, the criteria include: the same monthly criterion for schizophrenia (minimum duration of one month of symptoms), but not at 6 months of schizophrenia. In addition, for schizoaffective disorder, it is added that there must be 2 weeks without visible affective symptoms, but where delusions or hallucinations (psychotic symptoms) appear (criterion which is not included in schizophrenia) .

      2. Episodes / mood disorders

      In schizophrenia, it is excluded that there is a schizoaffective disorder in order to make the diagnosis. In addition, in this case, mood disorders are also excluded.

      In contrast, in schizoaffective disorder, mood disorders must be present for a diagnosis to be made (Major depressive episodes or manic episodes).

      3. Subtype

      In DSM-5, the schizophrenia subtypes are deleted (in DSM-IV-TR they were: paranoid, disorganized, catatonic, undifferentiated and residual schizophrenia, and in ICD-10 uncomplicated schizophrenia was also included ).

      In contrast, schizoaffective disorder includes the following subtypes: bipolar type (if the disorder includes a manic episode) and depressive type (if it includes major depressive episodes).

      4. Forecast

      Another of the differences between schizoaffective disorder and schizophrenia concerns the prognosis of the disorder. Thus, the prognosis of schizoaffective disorder is better than that of schizophrenia (although worse than that of mood disorders).

      5. Prevalence

      While the prevalence of schizophrenia varies from 0.3 to 0.7% according to the DSM-5 (the DSM-IV-TR placed it at 1%), the prevalence of schizoaffective disorder is lower, standing at 0.3% according to the DSM-5.

      6. Affective symptoms

      The sixth of the differences between schizoaffective disorder and schizophrenia concerns the affective symptoms (anhedonia, sadness, mania …).

      On the one hand, affective symptoms (mood) are of great importance in schizoaffective disorder; so much so that their presence is essential to be able to diagnose this disorder. As we have seen, there must be, at some point, a manic episode or a major depressive episode.

      On the other hand, in the case of schizophrenia, the affective symptoms are not essential for the diagnosis, Although they often appear in the form of negative symptoms such as: abulia, restricted emotional expression, flat ailment, depressive symptoms, etc. In addition, no major depressive episode or manic episode usually occurs in schizophrenia.

      7. Start

      The onset of the disorder is another of the differences between schizoaffective disorder and schizophrenia; like that, in schizoaffective disorder, the onset is usually acute, and in schizophrenia, insidious.

      8. Other differences between schizoaffective disorder and schizophrenia

      Other differences between schizoaffective disorder and schizophrenia refer to the frequency (or presence / absence) of certain symptoms, such as: auditory hallucinations, although they can occur in both disorders, occur more frequently in the patient. »Schizophrenia than in schizoaffective disorder; disorganization of thought is also more common in schizophrenia as well as emotional flattening. On another side, linguistic poverty is also more marked in schizophrenia.

      Finally, the symptom of confusion is more prevalent in schizoaffective disorder than in schizophrenia, where it usually does not appear.

      Bibliographical references:

      • American Psychiatric Association -APA- (2002). DSM-IV-TR Diagnostic and Statistical Manual. Barcelona: Masson.
      • American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Disorders mental. Madrid: Panamericana.
      • Belloch, A., Sandín, B. and Ramos, F. (2010). Manual of psychopathology. Volumes I and II. Madrid: McGraw-Hill.
      • Lermanda, V., Holmgren, D., Soto-Aguilar, F. and Sapag, F. (2013). Schizoaffective disorder. How many schizophrenia? How bipolar? Chilean Journal of Neuro-Psychiatry, 51 (1): 46-60.
      • WHO (2000). CIE-10. International Classification of Diseases, tenth edition. Madrid. Panamericana.

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