Friday, June 14, 2024

Major Depressive Disorder With Psychotic Features Vs Schizoaffective Disorder

What Medications Treat Schizoaffective Disorder

Schizoaffective vs BiPolar with psychotic features

The provider will figure out the right medicine based on the type of mood disorder the person has:

  • Antipsychotics: This is the primary medicine used to treat the psychotic symptoms that come with schizophrenia for example, delusions, hallucinations and disordered thinking.
  • Antidepressants: An antidepressant or mood stabilizer such as lithium can help treat mood-related symptoms. Sometimes, a person needs both an antidepressant and an antipsychotic.

A Difference In Treatment Styles

Why is it so important to know the differences between schizoaffective disorder vs schizophrenia? One reason is that both disorders require different approaches to treatment. Treating people for one condition when they suffer from the other does little to help.

For schizophrenia, most treatment revolves around antipsychotic medications, such as chlorpromazine and haloperidol. Schizoaffective disorder treatment also relies on antipsychotics, but the most common one that doctors prescribe is Paliperidone. In fact, its the only FDA-approved drug for this disorder.

With that said, there are some similarities in treatment as well. For example, attending therapy while taking appropriate medication is essential. Therapy can help people work through other issues that accompany these disorders. However, it isnt enough on its own, so they still have to take medication.

Strengths And Limitations Of The Study

The strengths of the present study include a defined catchment area, case inception via all routes to care , full diagnostic scope , and no arbitrary upper age cutoff high long-term follow-up was facilitated by the low geographical mobility of this rural population, together with primary care links established by the area mental health service that aims to deliver community-based treatment to patients where possible. The limitations of the study are typical of many such investigations, primarily the numbers of subjects involved, variations in treatment practice and compliance that may influence outcome, and the range of psychopathologies assessed. While well established and widely used for assessing psychosis, the PANSS may be less incisive for the assessment of affective psychopathology. Also, as expected, there were inevitably a modest number of diagnostic transitions, both from MDDP at inception to other diagnoses at 6-year follow-up and to MDDP at 6-year follow-up from other diagnoses at inception , as described previously in detail. The service delivery model in which CAMFEPS is embedded, focusing on community-based care, may limit generalizability to other clinical services. Future studies should further address these issues.

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How To Know Whether Psychotic Symptoms Are Schizoaffective Or Bipolar

Because psychotic symptoms can underlie a diagnosis of either bipolar or schizoaffective disorder, its important to take note of when the psychotic symptoms occur, for how long they occur, and when they go awayif at all. These criteria, when considered together, probably hold the most sway in distinguishing schizoaffective from bipolar disorder.

With bipolar disorder, psychotic symptoms can manifest when youre depressed or when youre manic. A key difference is that these symptoms tend to occur only when a person is having that mood episode, and once that mood episode has been controlled with the help of medication, the psychotic symptoms dissipate. For example, you can be manic for seven days, during which time you can be convinced youre a celebrity, but once you get treatment and the episode remits, those delusions of grandeur will pass.

In contrast, with schizoaffective disorder, the psychotic symptoms can occur seemingly out of the blue, are unattached to mood changes, and must occur for at least two weeks in order to be diagnosed as schizoaffective.

Bipolar With Psychotic Features

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Psychosis describes a disconnect from reality, a state of mind where you have trouble recognizing whats real and what isnt. In terms of bipolar disorder, psychosis mainly refers to hallucinations or delusions.

Other key symptoms of psychosis, such as changes in sleep patterns or problems with concentration, can seem very similar to those that characterize mood episodes.

Bipolar psychosis might involve:

These symptoms can be mood congruent, meaning theyre consistent with your other symptoms. They can also be mood incongruent, or inconsistent with your other symptoms. Believing you have superpowers during an episode of depression, for example, would be considered mood-incongruent psychosis.

Psychosis can happen during both manic and depressive episodes. An episode of hypomania that involves psychosis automatically meets the criteria for mania.

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Diagnostic Considerations In Major Depressive Disorder With Psychotic Features

Investigators highlighted the need for adequate diagnosis of psychotic features in patients with major depressive disorder during routine clinical care, according to study findings published in Journal of Clinical Psychiatry1

Patients with MDD may present with psychotic features, including hallucinations and delusions. In these patients, neurobiologic findings, clinical characteristics, family medical history, and treatment response patterns have been reported to differ significantly from patients with non-psychotic MDD.2-8

This observational, cross-sectional study included 1410 adults 18 years and older who met the criteria for MDD9 and had received treatment from one of ten European tertiary centersbetween 2011 and 2016. Investigators evaluated the presence of psychotic features using the Mini-International Neuropsychiatric Interview. Using various rating scales, specialists from the referral centers collected clinical, pharmacologic, and sociodemographic data from participants. The investigators examined the association between these variables and the occurrence of psychotic features using binary logistic regressions.


What Is Psychotic Depression

Psychotic depression is a major depressive episode that is accompanied by psychotic symptoms and requires hospitalization.

Psychotic depression is a subtype of depression, belonging to a group known as the group of mood disorders that includes a number of disorders in which symptoms of depression appear.

Psychotic depression involves a combination of clinical major depressive symptoms, with psychotic symptoms, and affects 15%-19% of major depressives. Also, this phenomenon occurs very rarely in postpartum depression .

Psychotic depression usually increases when symptoms of depression appear at a very severe level, especially in cases where there is a risk of suicide, delusion or other fears and cognitive impairment.

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3. Melancholic Depression: Symptoms and Causes

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Mood Congruent And Mood Incongruent Psychotic Symptoms

The diagnostic and prognostic importance of mood congruent and mood incongruent psychotic symptoms in mood disorders is the subject of ongoing discussion. Some investigators propose that mood incongruent psychotic features indicate a distinct subtype of psychotic depression with a worse prognosis regardless of the severity of depression . This point of view appeared to be supported by a finding that mood incongruent psychotic features aggregated in families and predicted a more severe course . In the Research Diagnostic Criteria, mood disorders with mood incongruent psychotic symptoms are grouped under schizoaffective disorder, based on the concept that mood incongruence conveys a worse course of mood disorders . On the other hand, there is considerable heterogeneity of outcome in these patients .

Regardless of how psychosis is categorized, the bulk of evidence suggests that there is no difference in outcome between psychotic depression with mood congruent versus mood incongruent symptoms . One point about which there is growing consensus is that mood incongruent psychotic symptoms convey greater likelihood of bipolar than unipolar depression .

Are There Different Types Of Schizoaffective Disorder


There are 3 main types of schizoaffective disorder:

What is manic type?

This means you have symptoms of schizophrenia and mania at the same time through a period of illness.

What is depressive type?

This means you have symptoms of schizophrenia and depression at the same time through a period of illness.

What is mixed type?

This means you have symptoms of schizophrenia, depression and mania through a period of illness.

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Psychotic Depression Vs Major Depression

MDD, or clinical depression, can affect your mood, behavior, everyday life, and physical health.

An episode of major depression typically involves:

  • a persistent low mood or a loss of interest in everyday life for at least 2 weeks
  • four or more other symptoms of depression

Psychosis isnt included in the nine main symptoms of depression, and many people living with MDD never experience psychosis.

The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition classifies the two separately, listing depression with features of psychosis as Other Specified Depressive Disorder.

Depression is always serious. Still, experts tend to consider MDD with psychosis more serious than depression without psychosis because its more likely to involve:

Psychosis involves a break or disconnect from reality, so people experiencing it arent necessarily aware of their symptoms, which can include:

  • hallucinations, or seeing, hearing, and feeling things that arent real
  • delusions, or believing things that arent true
  • psychomotor impairment, or slowed thoughts, movements, and feelings
  • a state of stupor, where youre unable to move, speak, or respond to your environment

Psychotic hallucinations and delusions might involve:

Experts separate MDD with features of psychosis into two categories:

What Is The Difference Between Schizoaffective Disorder And Schizophrenia

Schizophrenia and schizoaffective disorder have a significant overlap in symptoms. But schizoaffective disorder also involves symptoms of mood disorders like major depression or bipolar disorder, which makes it a more complicated condition to diagnose and treat. Both conditions are manageable, and no one who is diagnosed with either should be prevented from living a normal life over the long-term.

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Another Key Difference To Look For When Noticing Symptoms

Another key difference to look for is the presence of psychotic symptomsthe reason being that many people with bipolar disorder dont experience psychosis. Its therefore important for individuals and families to keep a record of symptoms. If Im able to rule out psychotic symptoms after conducting a detailed assessment of the patient, its more likely the case that the person has bipolar disorder, not schizoaffective disorder.

How Is Psychotic Depression Diagnosed

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People experiencing depression with psychosis dont always seek help on their own. In some cases, it might be a family member or close friend who helps them find a medical or mental health professional who can make a diagnosis.

To make a diagnosis, theyll generally start by asking questions about your mental health, mood, and emotional well-being. They might ask about:

  • fixed beliefs or persistent worries that affect your daily life
  • things you see, hear, or feel that no one else seems to notice
  • problems with sleeping, eating, or going about your daily life
  • your support network and social relationships
  • health concerns
  • other mental health symptoms, like anxiety or mania
  • your personal and family health and mental health history

Psychosis isnt always obvious, even to trained clinicians. Some mental health professionals may not immediately recognize the difference between fixed delusions and rumination, a pattern of looping sad, dark, or unwanted thoughts.

Both delusions and rumination, which is common with depression, can involve:

  • guilt over mistakes you believe youve made
  • perceptions of yourself as a failed partner or parent

Describing all of your feelings, perceptions, and beliefs to your clinician can help them make the right diagnosis.

A diagnosis of major depression also requires that symptoms:

  • last for 2 weeks or longer
  • affect some areas of daily life
  • arent related to substance use or another condition

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Mild And Transient Psychotic Symptoms

Research into the phenomenology and treatment of psychotic depression has primarily involved patients with easily identifiable, blatant psychotic symptoms. However, psychosis is a continuous rather than dichotomous phenotype across clinical diagnoses and subclinical psychotic-like experiences in the otherwise healthy general population . Yet, little is known about whether the impact of subtle or intermittent psychotic symptoms on the course and treatment response of mood disorders is similar to that of more obvious psychosis.

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Psychotic depression is taken very seriously by mental health professionals because the individual suffering from it is at an increased risk of self-harm.

The suicide rate in people with psychotic depression, when they are ill and in their acute phase, is much higher than it is with major depression, says Anthony J. Rothschild, MD, the Irving S. and Betty Brudnick Endowed Chair, Professor of Psychiatry at the University of Massachusetts Medical School in Worcester, Massachusetts and the author of the Clinical Manual for the Diagnosis and Treatment of Psychotic Depression.

Its important to distinguish psychotic depression from psychosis as well as schizophrenia, experts say. Psychosis by itself is not a disease, explains Timothy B. Sullivan, MD, chair of Psychiatry and Behavioral Sciences at Staten Island University Hospital in Staten Island, New York. Its not an illness in itself, just as fever is not an illness, he explains. Psychosis is caused by an impairment in the part of the brain that helps us discern what is happening internally versus what is happening externally.

While psychosis can look like schizophrenia, an individual with schizophrenia will have delusions and hallucinations regardless of whether they are depressed, says Ms. Nguyen.

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Schizoaffective Disorder Vs Major Depression Or Bipolar Disorder W/ Psychotic Features

I’ve never been very comfortable when I see patients diagnosed with Schizoaffective Disorder, because I have hard time understand how it can be distinguished from a mood disorder with psychotic features. Or, for that matter, simply schizophrenia concurrent with a mood disorder. I’ve worked in the field for about four years now I’ve talked to colleagues about this, looked around on the internet a bit, and tried to find related research, but I haven’t found a satisfying explanation as to why there needs to be a distinct schizoaffective diagnosis. Anyone care to help me understand?

How Neuropsychological Testing May Help With Diagnosing

What is Schizoaffective Disorder?

Thus far, there is not a definitive qEEG finding that, by providing a picture of the brain, allows us to distinguish between schizoaffective and bipolar disorders. Typically, with both disorders, there is often visible dysregulation in the prefrontal circuitry of the brain, suggesting impairment of executive function. In other words, both schizoaffective and bipolar disorder may manifest as dysregulation on a qEEG.

In these cases, neuropsychological testing may provide additional diagnostic information by allowing me to measure a patients executive functions such as problem-solving, organization and planning, and visual and verbal abstract reasoning. Typically, someone with schizoaffective disorder will be more severely impaired in these areas involving executive functioning, in addition to other neurocognitive domains such as processing speed and attention and vigilance. In contrast, someone with bipolar disorder may suffer impairment in these same areas but to a lesser degree.

In general, its safe to say that neurocognitive impairments are not as severe with bipolar disorder as they are with schizoaffective disorder.

Schizoaffective and bipolar disorders can be serious pathologies. In the event that you or a loved one is suffering from debilitating symptoms, early intervention and diagnosis are key to a better treatment outcome. When you insist on an accurate diagnosis, youll be furthering your own health and improving your quality of life.

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Continuation And Maintenance Treatment Of Major Depressive Disorder With Psychotic Features

Determining the optimal continuation and maintenance therapy for psychotic depression is of special concern due to the high rate of relapse observed in naturalistic follow-up studies of psychotic depression, including relapse after ECT. Other concerns include a relapsing or chronic course, high mortality rates,, a high risk of extrapyramidal symptoms and tardive dyskinesia with first-generation antipsychotics, risk of metabolic syndrome with atypical antipsychotics, an increased use of healthcare services, and a high rate of disability.

There is only 1 published randomized controlled trial of continuation pharmacotherapy for psychotic depression. In this study, the benefits and risks of combination pharmacotherapy with nortriptyline or sertraline plus perphenazine were compared with those of antidepressant monotherapy with nortriptyline or sertraline during a 26-week period in 28 older patients with psychotic depression who had remitted after being treated with ECT. Overall, 25% of patients relapsed during the 26-week trial, 33% in the combination therapy group, and 15% in the monotherapy group. The difference was not statistically significant most likely due to the small sample size.

In an open-label maintenance study, Rothschild and Duval assessed

Schizoaffective Vs Bipolar Disorder: How To Get An Accurate Diagnosis

Researchers and clinicians have made tremendous strides in diagnosing and treating mental health conditions. Yet, for all this progress, which should be a source of hope for individuals and families affected by mental illness, there is still a large gray area when it comes to diagnosing some disorders.

A case in point: schizoaffective disorder versus bipolar disorder, both of which may develop for the first time during early adulthood. In the first case, schizoaffective disorder can bear resemblances to schizophrenia and, its features can also be easy to misdiagnose as bipolar disorder . In fact, its very easy to misdiagnose schizoaffective disorder as bipolar disorder. This reality is only further complicated by the fact that bipolar disorder is itself commonly misdiagnosed and can be classified as either Bipolar 1 or Bipolar 2.

How then do you get an accurate diagnosis when its not entirely clear whether schizoaffective or bipolar disorder is the issue? As a psychologist who specializes in clinical neuropsychology and regularly works with this patient population, I often help individuals who may have been misdiagnosed get a correct diagnosis. What follow are insights based on that experience, in the hope they can help you, a loved one, or a friend, get a correct diagnosis.

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Causes Of Schizoaffective Disorder

Scientists donât know the exact cause. Risk factors for schizoaffective disorder include:

  • Genetics: You may inherit a tendency to get features linked to schizoaffective disorder from your parents.
  • Brain chemistry and structure: If you have schizophrenia and mood disorders, you might have problems with brain circuits that manage mood and thinking. Schizophrenia is also tied to lower levels of dopamine, a brain chemical that also helps manage these tasks.
  • Environment: Some scientists think things like viral infections or highly stressful situations could play a part in getting schizoaffective disorder if youâre at risk for it. How that happens isnât clear.
  • Drug use: Taking mind-altering drugs.

Schizoaffective disorder usually begins in the late teen years or early adulthood, often between ages 16 and 30. It seems to happen slightly more often in women than in men. It’s rare in children.

Because schizoaffective disorder combines symptoms that reflect two mental illnesses, itâs easily confused with other psychotic or mood disorders. Some doctors may diagnose schizophrenia. Others may think itâs a mood disorder. As a result, itâs hard to know how many people actually have schizoaffective disorder. Itâs probably less common than either schizophrenia or mood disorders alone.

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