-
Annals of Clinical Psychiatry :... Feb 2019Schizoaffective disorder (SAD) is a chronic, potentially disabling psychotic disorder common in clinical settings. SAD often has been used as a diagnosis for individuals... (Review)
Review
BACKGROUND
Schizoaffective disorder (SAD) is a chronic, potentially disabling psychotic disorder common in clinical settings. SAD often has been used as a diagnosis for individuals having an admixture of mood and psychotic symptoms whose diagnosis is uncertain. Its hallmark is the presence of symptoms of a major mood episode (either a depressive or manic episode) concurrent with symptoms characteristic of schizophrenia, such as delusions, hallucinations, or disorganized speech.
METHODS
A literature search in PubMed and Google Scholar was conducted to identify articles on SAD. We also reviewed major textbooks and DSM-5 to identify pertinent information.
RESULTS
This review begins with the history and classification of SAD. Debate continues to swirl around the concept, as some experts view SAD as an independent disorder, while others see SAD as either a form of schizophrenia or a mood disorder. The disorder is more common in women and its course follows the middle ground between schizophrenia and bipolar disorder. SAD appears to have high heritability. Most patients appear to benefit from antipsychotics plus antidepressants and/or mood stabilizers, depending on whether the patient has the depressive or bipolar subtype. Electroconvulsive therapy can also be effective.
CONCLUSIONS
SAD is a chronic psychotic disorder that continues to be controversial. There has been inadequate research regarding its epidemiology, course, etiologic factors, and treatment.
Topics: Antipsychotic Agents; Australia; History, 20th Century; History, 21st Century; Humans; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology
PubMed: 30699217
DOI: No ID Found -
Journal of the American Academy of... May 2018Psychosis is characterized by overt disruptions in thought, perceptions, and behavior. Complex syndromes presenting with psychosis, including schizophrenia spectrum... (Review)
Review
Psychosis is characterized by overt disruptions in thought, perceptions, and behavior. Complex syndromes presenting with psychosis, including schizophrenia spectrum disorders, mood disorders, and medical illnesses, are differentiated by characteristic patterns of symptom presentation and course of illness. Accurate diagnosis is important to guide treatment and to avoid inaccurate labeling, because most youth reporting psychotic-like experiences do not have a true psychotic disorder.
Topics: Adolescent; Age of Onset; Antipsychotic Agents; Child; Diagnosis, Differential; Hallucinations; Humans; Psychotic Disorders; Schizophrenia
PubMed: 29706159
DOI: 10.1016/j.jaac.2018.01.021 -
International Review of Psychiatry... 2023Substance-induced psychosis is a secondary psychotic disorder resulting from drug abuse, characterized by one or more psychotic episodes. Drug-induced psychosis is... (Review)
Review
Substance-induced psychosis is a secondary psychotic disorder resulting from drug abuse, characterized by one or more psychotic episodes. Drug-induced psychosis is expected to resolve after a 30-day period of sobriety, however, individuals with this condition are more likely to develop severe drug addiction. Compared to primary psychosis, participants with drug-induced psychosis exhibit poorer family history of psychotic diseases, higher insight, fewer positive and negative symptoms, more depressive symptoms, and greater anxiety. Substance-induced psychosis is strongly associated with the emergence of bipolar illness or schizophrenia spectrum disorder, with an increased chance of developing schizophrenia at a younger age. Episodes of self-harm after substance-induced psychosis are strongly linked to an elevated likelihood of developing schizophrenia or bipolar disorder. Effective treatment involves ruling out emergencies, investigating underlying causes, and addressing acute intoxication and withdrawal. Management includes dynamic assessment, intervention, and vigilant monitoring in cases of suicidal behaviour. Antipsychotics may be used for short term, with gradual discontinuation when a person is in a stable condition. Relapse prevention strategies, both medication and non-medication-based, are crucial in long-term management. Conversion rates to schizophrenia or bipolar disorder can be as high as one in three individuals, with users and those with early-onset substance abuse at the highest risk.
Topics: Humans; Psychotic Disorders; Schizophrenia; Bipolar Disorder; Antipsychotic Agents; Substance-Related Disorders
PubMed: 38299647
DOI: 10.1080/09540261.2023.2261544 -
Alcohol Research : Current Reviews 2019Schizophrenia and schizoaffective disorder are schizophrenia spectrum disorders that cause significant disability. Among individuals who have schizophrenia or... (Review)
Review
Schizophrenia and schizoaffective disorder are schizophrenia spectrum disorders that cause significant disability. Among individuals who have schizophrenia or schizoaffective disorder, alcohol use disorder (AUD) is common, and it contributes to worse outcomes than for those who do not have co-occurring substance use disorder. Common neurobiological mechanisms, including dysfunction in brain reward circuitry, may explain the high rates of co-occurrence of schizophrenia and AUD or other substance use disorders. Optimal treatment combines pharmacologic intervention and other therapeutic modalities to address both the psychotic disorder and AUD. Further research on the etiology of these co-occurring disorders and on treatment of affected individuals is needed.
Topics: Alcohol Deterrents; Alcoholism; Antipsychotic Agents; Comorbidity; Humans; Prognosis; Psychotherapy; Psychotic Disorders; Schizophrenia
PubMed: 31886105
DOI: 10.35946/arcr.v40.1.06 -
CNS Spectrums Aug 2016The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was published by the American Psychiatric Association (APA) in 2013, and the Work Group... (Review)
Review
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was published by the American Psychiatric Association (APA) in 2013, and the Work Group on the Classification of Psychotic disorders (WGPD), installed by the World Health Organization (WHO), is expected to publish the new chapter about schizophrenia and other primary psychotic disorders in 2017. We reviewed the available literature to summarize the major changes, innovations, and developments of both manuals. If available and possible, we outline the theoretical background behind these changes. Due to the fact that the development of ICD-11 has not yet been completed, the details about ICD-11 are still proposals under ongoing revision. In this ongoing process, they may be revised and therefore have to be seen as proposals. DSM-5 has eliminated schizophrenia subtypes and replaced them with a dimensional approach based on symptom assessments. ICD-11 will most likely go in a similar direction, as both manuals are planned to be more harmonized, although some differences will remain in details and the conceptual orientation. Next to these modifications, ICD-11 will provide a transsectional diagnostic criterion for schizoaffective disorders and a reorganization of acute and transient psychotic and delusional disorders. In this manuscript, we will compare the 2 classification systems.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases; Psychotic Disorders; Schizophrenia; Schizophrenia, Paranoid; Schizotypal Personality Disorder
PubMed: 27418328
DOI: 10.1017/S1092852916000316 -
Journal of Child Psychology and... Jul 2023Psychotic symptoms, including hallucinations, delusions, and disorganized thinking and behaviors, are the hallmarks of schizophrenia; but may also present in the context... (Review)
Review
Psychotic symptoms, including hallucinations, delusions, and disorganized thinking and behaviors, are the hallmarks of schizophrenia; but may also present in the context of other psychiatric and medical conditions. Many children and adolescents describe psychotic-like experiences, which can be associated with other types of psychopathology and past experiences (e.g., trauma, substance use, and suicidality). However, most youth reporting such experiences do not have, nor will ever develop, schizophrenia or another psychotic disorder. Accurate assessment is critical because these different presentations have different diagnostic and treatment implications. For this review, we focus primarily on the diagnosis and treatment of early onset schizophrenia. In addition, we review the development of community-based first-episode psychosis programming, and the importance of early intervention and coordinated care.
Topics: Adolescent; Child; Humans; Psychotic Disorders; Schizophrenia; Hallucinations; Suicidal Ideation; Psychopathology; Delusions
PubMed: 36878476
DOI: 10.1111/jcpp.13777 -
Neuropsychology Review Dec 2018Individuals with disorders that include psychotic symptoms (i.e. psychotic disorders) experience broad cognitive impairments in the chronic state, indicating a dimension... (Review)
Review
Individuals with disorders that include psychotic symptoms (i.e. psychotic disorders) experience broad cognitive impairments in the chronic state, indicating a dimension of abnormality associated with the experience of psychosis. These impairments negatively impact functional outcome, contributing to the disabling nature of schizophrenia, bipolar disorder, and psychotic depression. The robust and reliable nature of cognitive deficits has led researchers to explore the timing and profile of impairments, as this may elucidate different neurodevelopmental patterns in individuals who experience psychosis. Here, we review the literature on cognitive deficits across the life span of individuals with psychotic disorder and psychotic-like experiences, highlighting the dimensional nature of both psychosis and cognitive ability. We identify premorbid generalized cognitive impairment in schizophrenia that worsens throughout development, and stabilizes by the first-episode of psychosis, suggesting a neurodevelopmental course. Research in affective psychosis is less clear, with mixed evidence regarding premorbid deficits, but a fairly reliable generalized deficit at first-episode, which appears to worsen into the chronic state. In general, cognitive impairments are most severe in schizophrenia, intermediate in bipolar disorder, and the least severe in psychotic depression. In all groups, cognitive deficits are associated with poorer functional outcome. Finally, while the generalized deficit is the clearest and most reliable signal, data suggests specific deficits in verbal memory across all groups, specific processing speed impairments in schizophrenia and executive functioning impairments in bipolar disorder. Cognitive deficits are a core feature of psychotic disorders that provide a window into understanding developmental course and risk for psychosis.
Topics: Bipolar Disorder; Cognitive Dysfunction; Humans; Psychotic Disorders; Schizophrenia
PubMed: 30343458
DOI: 10.1007/s11065-018-9388-2 -
Actas Espanolas de Psiquiatria Sep 2019Schizoaffective disorder (SAD) is a psychotic disorder which has presented a certain nosological controversy. Apart from these difficulties, very few studies focused in... (Review)
Review
Schizoaffective disorder (SAD) is a psychotic disorder which has presented a certain nosological controversy. Apart from these difficulties, very few studies focused in SAD as a distinct condition from schizophrenia have been found. This lack of specifical studies on SAD results in a lack of specific evidence about treatment. Currently, its treatment is based mainly on the use of antipsychotics, although there are no specific treatment guidelines for SAD. The objective of this review is to establish which are the most recommended treatments according to evidence available, considering clinical variables such as efficacy, safety, adherence, and tolerance as well as the role of these factors in different subtypes of SAD. This exhaustive review examines experimental and observational studies involving patients with a diagnosis of SAD. It was concluded that more clinical trials performed exclusively on patients affected by SAD are needed. Paliperidone, the only drug with authorized use in SAD, is the one that has the highest quality of studies to support its use. Risperidone, olanzapine, aripiprazole and ziprasidone also have randomized clinical trials supporting their efficacy and safety. In treatment-refractory patients, there are observational studies indicating the usefulness of clozapine. Likewise, there is evidence from observational studies showing the usefulness of lithium and carbamazepine during the treatment maintenance phase. It is necessary to establish the role of combined treatment with mood stabilizers and/or antidepressants.
Topics: Humans; Psychopharmacology; Psychotic Disorders; Psychotropic Drugs
PubMed: 31648341
DOI: No ID Found -
The Psychiatric Clinics of North America Mar 2021Autism seldom occurs in its pure form. Often labeled as behavioral disorders or psychological reactions, comorbid psychiatric disorders are common. Bipolar disorder is... (Review)
Review
Autism seldom occurs in its pure form. Often labeled as behavioral disorders or psychological reactions, comorbid psychiatric disorders are common. Bipolar disorder is one of the most common psychiatric disorders that occur in persons with autism across their life spans. It can be comorbid with and mistaken for several other conditions. Similarly, psychosis occurs in several psychiatric disorders. Schizophrenia is the prototype psychotic disorder that has a close but controversial relationship with autism. Assessment and treatment of bipolar disorder and psychosis should be based on their individual characteristics, family dynamics, and community resources.
Topics: Autistic Disorder; Bipolar Disorder; Humans; Psychotic Disorders; Schizophrenia
PubMed: 33526231
DOI: 10.1016/j.psc.2020.11.001 -
Fortschritte Der Neurologie-Psychiatrie Feb 2020Acute psychotic disorders (APS) are characterized by an acute onset as well as a wide array of symptoms including affective, psychotic, and psychomotor symptoms. They... (Review)
Review
Acute psychotic disorders (APS) are characterized by an acute onset as well as a wide array of symptoms including affective, psychotic, and psychomotor symptoms. They occur independently of substance use or organic disorders. In most cases, patients recover fully and without residues within a short period of time. However, APS tend to show a relapsing course, and transitions into other psychiatric disorders (schizophrenia, bipolar disorder) may occur.
Topics: Acute Disease; Bipolar Disorder; Humans; Psychotic Disorders; Recurrence; Schizophrenia
PubMed: 32102104
DOI: 10.1055/a-1008-7510