Schizoaffective Disorder
Schizoaffective disorder combines features of schizophrenia and a mood disorder, defined per DSM-5-TR.
Symptoms
Psychotic symptoms (hallucinations, delusions) alongside a major mood episode (depression or mania), with the key distinguishing feature being at least 2 weeks of psychosis occurring without mood symptoms at some point in the illness.
Causes and risk
Similar genetic and environmental risk factors to schizophrenia and bipolar disorder, since schizoaffective disorder shares features with both.
How it is evaluated
Diagnosis requires careful longitudinal history to confirm psychosis has occurred independent of mood episodes (distinguishing it from a mood disorder with psychotic features) and that mood symptoms are present for the majority of the illness (distinguishing it from schizophrenia).
Treatment
Antipsychotics are foundational, with clozapine and long-acting injectables associated with the best real-world outcomes, per real-world effectiveness data; mood stabilizers or antidepressants are added depending on the mood subtype, alongside psychoeducation.
When to seek care
Suicidal or homicidal ideation, command hallucinations, catatonia, severe disorganization, or an inability to care for oneself all warrant urgent evaluation, per VA/DoD guideline indications -- call 911 or the 988 Suicide and Crisis Lifeline.