Schizoaffective disorder

Diagnostic and statistical manual of mental disorders, 5th edition text revision (DSM-5-TR), criteria[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.

1. An uninterrupted period of illness, during which there is a major mood episode (major depressive or manic) concurrent with a schizophrenia episode characterized by two or more of the following symptoms present for a considerable part of a 1-month period (at least one of these must be delusions, hallucinations, or disorganized speech):

   • Delusions

   • Hallucinations

   • Disorganized speech (e.g., frequent derailment or incoherence)

   • Grossly disorganized or catatonic behavior

   • Negative symptoms (i.e., diminished emotional expression or avolition).

2. During this time, there should be a period of at least 2 weeks with delusions and hallucinations, in the absence of a major mood episode (depressive or manic) during the lifetime duration of illness.

3. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual period of illness.

4. Other possible etiologies such as substances (e.g., illicit drugs, medication) or general medical conditions have been ruled out.

Specify whether bipolar type (if manic episode is part of the presentation; major depressive episodes may also occur) or depressive type (if only major depressive episodes are part of the presentation).

Specify if: with catatonia.

Specify if: (the following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria)

• First episode, currently in acute episode

• First episode, currently in partial remission

• First episode, currently in full remission

• Multiple episode, currently in acute episode

• Multiple episode, currently in partial remission

• Multiple episode, currently in full remission

• Continuous

• Unspecified.

International statistical classification of diseases and related health problems, 11th revision (ICD-11), criteria[2]World Health Organization. ICD-11 for mortality and morbidity statistics. Feb 2022 [internet publication]. https://icd.who.int/browse11/l-m/en

An episodic disorder characterized by the presence of prominent schizophrenia and affective symptoms (manic, moderate or severe depressive, or mixed) during the same episode, either simultaneously or within a few days of each other. Symptoms must persist for at least 1 month, and are not due to a medical condition or the effect of substance or medication use.

Reliability

• Diagnostic reliability is much lower for schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar depression.[38]Cheniaux E, Landeira-Fernandez J, Versiani M. The diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder and unipolar depression: interrater reliability and congruence between DSM-IV and ICD-10. Psychopathology. 2009;42(5):293-8. http://www.ncbi.nlm.nih.gov/pubmed/19609099?tool=bestpractice.com [39]Jäger M, Haack S, Becker T, et al. Schizoaffective disorder: an ongoing challenge for psychiatric nosology. Eur Psychiatry. 2011 Apr;26(3):159-65. http://www.ncbi.nlm.nih.gov/pubmed/20646917?tool=bestpractice.com

• The differences in DSM-IV and ICD-10 diagnostic criteria resulted in low diagnostic congruence for schizoaffective disorder.[38]Cheniaux E, Landeira-Fernandez J, Versiani M. The diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder and unipolar depression: interrater reliability and congruence between DSM-IV and ICD-10. Psychopathology. 2009;42(5):293-8. http://www.ncbi.nlm.nih.gov/pubmed/19609099?tool=bestpractice.com Differences continue to exist between the DSM-5 and ICD-11.