Schizaffective DO: questions

[whopper]

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Question: Food for thought for all of you.

The current DSM criteria & its K&S description for schizoaffective DO brings up some questions.

Let's say that we got a patient that meets both criteria for Schizophrenia (the type doesn't matter) & major depressive DO that set in after he was dx'd with schizophrenia. He became depressed as a result of his socioeconomic fall that happened 2ndary to his schizophrenia.

Does this person have schizophrenia & major depressive disorder? OR does he now have schizoaffective? Where exactly is the line drawn?

K&S writes that there is still debate as to whether or not Schizoaffective is a distinct disease entitiy unto itself or if it merely a schizophrenic person who has a comorbid affective DO, or someone with an affective DO that later attains enough psychotic sx (not due to the effects of the affective DO).

Any insights or advances in this area that can answer my question that I don't know about?

 

[TheWowEffect]

Question: Food for thought for all of you.

The current DSM criteria & its K&S description for schizoaffective DO brings up some questions.

Let's say that we got a patient that meets both criteria for Schizophrenia (the type doesn't matter) & major depressive DO that set in after he was dx'd with schizophrenia. He became depressed as a result of his socioeconomic fall that happened 2ndary to his schizophrenia.

Does this person have schizophrenia & major depressive disorder? OR does he now have schizoaffective? Where exactly is the line drawn?

K&S writes that there is still debate as to whether or not Schizoaffective is a distinct disease entitiy unto itself or if it merely a schizophrenic person who has a comorbid affective DO, or someone with an affective DO that later attains enough psychotic sx (not due to the effects of the affective DO).

Any insights or advances in this area that can answer my question that I don't know about?

Schizoaffective is such a cop out diagnosis. I have rarely found a pt with this diagnosis who "really" met the criteria. I have heard one well known psychosis researcher say that it might be thrown out of the future DSM.

 

[nancysinatra]

Schizoaffective is such a cop out diagnosis. I have rarely found a pt with this diagnosis who "really" met the criteria. I have heard one well known psychosis researcher say that it might be thrown out of the future DSM.

That's really interesting. See, I would have thought a cop out would be to just say the pt has schizophrenia and depression, because then you do not have to go to the effort of proving that the pt meets the specific criteria for schizoaffective. Are pts given this diagnosis even when they don't really fit the description? I wonder why? I just wouldn't have expected that...

 

[strangeglove]

Why does it matter, since you are going to treat them similarly?

 

[TheWowEffect]

Why does it matter, since you are going to treat them similarly?

I think it matters when there are subtle and not-so-subtle differences between the negative symptoms of schizophrenia and clear cut affective states. The treatment would then differ.

In the current CMH-based-quick-diagnose-treat day & age, it is really important that these things are better defined. How many times have we seen- "Mood swings= Bipolar disorder" or "Hearing voices=Schizophrenia". Patients move from one clinic to another-they have million diagnoses and have been tried on trillion meds.😡

Go figure!!!

 

[manwhoisthursdy]

Question: Food for thought for all of you.

The current DSM criteria & its K&S description for schizoaffective DO brings up some questions.

Let's say that we got a patient that meets both criteria for Schizophrenia (the type doesn't matter) & major depressive DO that set in after he was dx'd with schizophrenia. He became depressed as a result of his socioeconomic fall that happened 2ndary to his schizophrenia.

Does this person have schizophrenia & major depressive disorder? OR does he now have schizoaffective? Where exactly is the line drawn?

K&S writes that there is still debate as to whether or not Schizoaffective is a distinct disease entitiy unto itself or if it merely a schizophrenic person who has a comorbid affective DO, or someone with an affective DO that later attains enough psychotic sx (not due to the effects of the affective DO).

Any insights or advances in this area that can answer my question that I don't know about?

Don't the criteria require that you have mood symptoms during at least a 2 week period (or something like that) *without* psychotic sx? Do I have that right? So you don't just have psychotic and depressive sx at the same time.

Also, doesn't schizoaffective d/o have a *better* prognosis than schizophrenia, but not as good as mood d/o? Why would having schizophrenia AND a comorbid mood d/o be better than just schizophrenia? To me this suggests, though does not prove at all, that there's something to schizoaffective d/o even if it's really a schizophrenia subtype, or something we very poorly understand.

 

[strangeglove]

I think it matters when there are subtle and not-so-subtle differences between the negative symptoms of schizophrenia and clear cut affective states. The treatment would then differ.

I agree, but the initial question was not about distinguishing between the negative symptoms of schizophrenia and "clear cut affective states" (presumably by which you mean mood symptoms), it was about differentiating between depression that came after the onset of schizphrenia versus schizoaffective disorder, which are not that different in terms of treatment. I agree completely that negative symptoms are frequently mischaracterized as depression and vice-versa, and you can't treat negative symptoms with antidepressants. I also think the prodrome of schizophrenia is often confused with depression.

 

[Solideliquid]

Well, to the above with the two week question. If he had been depressed and psychotic at the same time then the Dx would be Depression w/Psychotic feat right?


If you have an individual with a dx of schizophrenia (for say 10 yrs) then this person develops MDD, (or has at least an episode of major depression, or depression NOS) you would say schizophrenia and MDD, single episode or whatever.

In my mind, you can have schizoaffective disorder if there is a long timeline of both depression and schizophrenia, but of course the mood disorder occurs mostly separate from the psychotic symptoms.

 

[whopper]

Why does it matter, since you are going to treat them similarly?

Practically-yes, but academically and intellectually-no (I want to understand the disease as best I can).

The DSM has this diagnosis but there's a lack of clarity on it as a specific disease entity other than its sx. Add to that, which meds are indicated for it? The answer adds to the lack of clarity of this DO as a specific disease entity. If its not a specific disease, but instead a combination of 2 diseases (e.g. schizophrenia & an affective DO), why not just make it 2 separate diagnosises? (I know the DSM psychosis criteria for schizoaffective are not as detailed as for schizophrenia).