Schizoaffective Disorder: A Care Staff Guide

Schizoaffective disorder sits between two conditions staff often know better: schizophrenia and mood disorders such as bipolar disorder. Because its symptoms come from both sides, it can be confusing for the person, their family and the team supporting them. Understanding how the pieces fit together helps staff to notice early warning signs, respond kindly and support the treatment plan.

What is schizoaffective disorder?

Rethink Mental Illness describes schizoaffective disorder as a mental illness that combines symptoms of schizophrenia and mood disorders, like mania or depression, or both. It can affect thoughts, emotions and behaviour. Our guides to psychosis and schizophrenia and bipolar disorder explain the two conditions it draws on.

Symptoms

Rethink groups the symptoms into three areas:

• Psychosis: hallucinations, delusions, disorganised speech and behaviour, catatonic behaviour, and negative symptoms such as low motivation, reduced emotional range and less interest in socialising.
• Mania: feeling overly energetic or irritable, racing thoughts, needing little sleep, overconfidence and risky behaviour.
• Depression: low mood, low energy, hopelessness, guilt, poor concentration, changes in sleep and appetite, and thoughts of death or suicide.

These can occur together or at different times. A person may be well for periods and then become unwell, so the pattern matters as much as any single symptom.

How common is it, and what causes it?

Rethink says accurate figures are hard to find and that schizoaffective disorder is less common than schizophrenia, which affects around 1 in 100 people according to the Royal College of Psychiatrists. Psychiatrists do not know the exact cause. Rethink notes that genetics may play a part, with the condition slightly more common if relatives have schizophrenia, schizoaffective disorder or bipolar disorder, and that stress such as bereavement, debt or job problems can contribute to an episode. Childhood trauma may raise the risk.

How is it diagnosed?

A psychiatrist makes the diagnosis after a mental health assessment, which may need more than one appointment. Rethink explains that diagnosis uses ICD-11 or DSM-5 and requires both psychosis and mood symptoms, present for several weeks, and not caused by another condition, substance or medication. Staff should never attempt to diagnose, but accurate, dated observations help clinicians a great deal.

Treatment and support

Treatment follows the approaches used for its component conditions. For psychotic symptoms this usually includes antipsychotic medication, together with psychosocial treatment, psychoeducation, family intervention and talking therapy. For depression, talking treatments, medication and self-help are used. For mania, mood-stabilising medication is usual, sometimes with psychological therapy. Teams that may be involved include early intervention in psychosis teams, community mental health teams, crisis teams, assertive outreach teams and the GP, who can monitor symptoms and prescribe repeat medication. Peer support, recovery colleges and a wellness action plan can also help.

What staff can do

• Learn the person's early warning signs. Changes in sleep, energy, speech, appetite or withdrawal often come before a relapse. Write them into the care plan.
• Support medicines. Take concerns about side effects seriously and raise them with the prescriber rather than encouraging the person to stop.
• Respond calmly to unusual beliefs and experiences. Do not argue or collude. Listen, acknowledge how frightening or distressing it feels and focus on safety and comfort.
• Take thoughts of death seriously. Rethink notes that suicide risk is higher for people with the condition. Follow your procedure, and see our guide to suicide and self-harm awareness.
• Keep routines steady. Regular sleep, meals and activity help in both low and high mood.

Recording and care planning

Good records help the team spot patterns. Note changes in mood, sleep, speech and behaviour with dates and times, use the person's own words where possible, and keep the language neutral and respectful. Make sure the care plan sets out what helps when the person is unwell, who to contact and which crisis service to call, and agree it with the person so it reflects their wishes. Review it after every relapse, hospital stay or change of medicine, and share updates with night and agency staff so that everyone responds in the same calm and consistent way.

Supporting families and carers

Rethink advises that carers can ask social services for a carer's assessment, use family therapy through the NHS and join carers' groups. Offer relatives clear information, a named contact, and the chance to be involved in care planning, with the person's consent. Ask to see the person's care plan and recovery plan so that everyone is working towards the same goals.

Supporting staff learning

Understanding complex presentations builds confidence and reduces fear. You can explore options in Learnsignal's CPD library for care and healthcare staff.

Frequently asked questions

Is schizoaffective disorder the same as schizophrenia? No. It involves psychosis and mood symptoms such as mania or depression, according to Rethink Mental Illness.

Can people recover? Many people live well with the right treatment and support. A wellness action plan, peer support and consistent care all help.

Who diagnoses it? A psychiatrist, following an assessment that may need more than one appointment.