Treatment for schizoaffective disorder

Drug treatments, along with more psychosocial therapies, are necessary to successfully treat schizoaffective disorder. Drug therapy usually can stop the patient's psychosis, but often only social and occupational rehabilitation therapies can overcome the associated unemployment, poverty and homelessness.

Medication

Schizoaffective disorder appears to be a combination of thought, mood, and anxiety disorders. This means that the medical management of schizoaffective disorder often requires a combination of antipsychotic, antidepressant and anti-anxiety medications.

Unfortunately, after the first year of treatment, only a minority of schizoaffective outpatients continue to take their medication. Because of this, long-acting depot (injected) antipsychotic medications are usually required to overcome this non-compliance.

  • The older (tricyclic) antidepressants often worsen schizoaffective disorder. However, the newer (serotonergic) antidepressants have dramatically benefited many apathetic or depressed schizoaffective patients. Antidepressant use needs to be carefully monitored because it can trigger manic episodes
  • Benzodiazepines often can dramatically reduce agitation and anxiety of schizoaffective disorder. This is often especially true for those suffering from catatonic excitement or stupor
  • Mood stabilisers are often added on a trial basis if the patient has not responded to antipsychotic treatment alone

Schizoaffective disorder is often accompanied by unemployment, poverty and homelessness and as such drug therapy alone usually is insufficient.

Psychosocial treatments

Traditional psychotherapy (like counseling) is not recommended for people with schizoaffective disorder. Supportive therapy, which may include advice, reassurance, education, modelling, limit setting, and reality testing, is generally the therapy of choice.

Three people talking

Group therapy
 This therapy combined with drugs, produces somewhat better results than drug treatment alone. It has been found to be most successful when undertaken in an inpatient setting.

Positive results are more likely to be obtained when group therapy focuses on: real-life plans, problems and relationships; on social and work roles and interaction in cooperation’s with drug therapy and discussion of its side effects and involves some practical recreational or work activity.

This supportive group therapy can be especially helpful in decreasing social isolation and increasing reality testing.

Family intervention
Family therapy can significantly decrease relapse rates for a person with schizoaffective disorder. In high-stress families, a person with schizophrenia may have a 50-60% chance of aftercare relapse in the first year out of hospital. Supportive family intervention can reduce this relapse rate to below 10%. Self help groups, in which family members of schizoaffective patients discuss and share issues, have also been particularly helpful.

Behavioural therapies
When a schizoaffective patient is no longer psychotic or distractible, behaviour therapy can successfully teach much needed social and occupational skills. Cognitive behaviour therapy has been found to be particularly effective.

Risk of harm

Between 30-40% of people with schizoaffective disorder will attempt suicide during their lifetime and 10% of them will succeed. Should it be appropriate, treatment with lithium and/or clozapine can reduce the chance of suicide in people with schizoaffective disorder.