Family and Caregiver Schizophrenia Discussion Forum

Schizophrenia vs. schizoaffective disorder

I was just told by a nurse practitioner who works with my child’s psychiatrist that my child has schizoaffective disorder and that it is when a person still has psychosis and medication has not taken it completely away and that schizophrenia is when the psychosis is gone using meds. But the way I understood it is schizoaffective disorder is someone with pshycosis + bipolar or some other mood disorder. I, however, still think it is schizophrenia. I told the nurse that she does not have any depressive or manic episodes. We will have another consult with the psychiatrist soon to discuss this.
Does anyone know anything about the difference?

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My understanding is that schizoaffective has symptoms of schizophrenia with the mood components of bipolar.
I don’t think it has anything to do with meds working.

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I agree that schizoaffective is schizophrenia and any other mood disturbance, my sister has schizoaffective disorder and my son has disorganized schizophrenia, I see the differences.
I found this definition of “affective disorder”

affective disorder
(Psychiatry) any mental disorder, such as depression or mania, that is characterized by abnormal disturbances of mood

Here is a reasonable summary of the differences:

compared to:

That’s exactly what I thought when I spoke with the nurse practitioner Catherine. I could not figure out how someone with psychosis not able to be taken away with meds meant schizoaffective and someone where the meds took away the psychosis meant schizophrenia. I mean aren’t there a lot of people with schizophrenia who still have psychosis from time to time? Her explanation was very confusing. My daughter had been diagnosed with being bipolar a couple of years ago by a different nurse practioner (not even a psychiatrist) at the same facility she is being treated at. I told the nurse, she is definitely not bipolar and never should have been diagnosed as having it. I’m glad the nurse is setting up a conference between my daughter and the psychiatrist and myself. He seems like a very good doctor, but basically went off the history on her medical records. Oh, and my daughter signed a medical release for me to speak with all the health care providers at the clinic, that’s how I was able to sit in on her appointment with the nurse today. I’m hoping to get more info when we meet with the doctor.

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I don’t think the definition has anything to do with the meds. I mean some meds work and some do not and sometimes you need a mix of meds to make it work, regardless of the diagnosis. It is true that even on the proper medication a schizophrenic, or a schizoaffective can still suffer a psychosis from time to time and it doesn’t always mean the meds are wrong. My sz son has been stable for several years but if under intense stress he may become psychotic for a short time until the stress is gone and the meds are able to do their job, then he is quite stable again. It happens rarely and I guard against intense stress for him. Getting the correct diagnosis is key to recovery. I am so glad you are getting to sit in on a conference with your daughter and that you got the medical release. You should be able to get all of the first hand information you need to go forward with the correct treatment for your daughter. My very best to you and her. :slight_smile:

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It looks like they may change my son’s diagnosis from schizophrenia to schizoaffective because he has a major mood component. I was never sure if the not sleeping was stress related or mania (maybe both?), but they’re saying it’s him going manic.

They added a mood stabilizer to his meds in the hospital & it’s really, really slowed him down. I didn’t catch which one it was - just not a name I recognized. He hasn’t called me all day long & cut our visit short last night so he could go lay down. If sleeping all the time is a side effect, I hope it goes away. As much as I want him to sleep enough, I don’t want it to be the only thing he does.

I’ll take it short term though if it means keeping him out of the hospital.

Now, I’ll have to figure out the difference between Bipolar I & Schizoaffective.


I found this definition on ~and there is a good link at the bottom from Mental Health America

*Bipolar disorder: A mood disorder sometimes called manic-depressive illness or manic-depression that characteristically involves cycles of depression and elation or mania. Sometimes the mood switches from high to low and back again are dramatic and rapid, but more often they are gradual and slow, and intervals of normal mood may occur between the high (manic) and low (depressive) phases of the condition. The symptoms of both the depressive and manic cycles may be severe and often lead to impaired functioning.

Both phases of the disease are deleterious. Mania affects thinking, judgment, and social behavior in ways that may cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when an individual is in a manic phase. Depression can also affect thinking, judgment, and social behavior in ways that may cause grave problems. For example, it elevates the risk of suicide. About 5.7 million American adults, or about 2.6 percent of the population aged 18 and older, have bipolar disorder.

Although bipolar disorder often worsens over time if untreated, most people with bipolar disorder can achieve stabilization of their mood swings and reduction of symptoms with proper treatment. Treatment usually consists of medications known as “mood stabilizers.”*

This link goes into greater detail about schizoaffective disorder and how it can be confused with bi polar disorder…

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Thank you Catherine - that was very helpful.

I think until this past year, bipolar might have been more appropriate. Now, I just don’t know.


Catherine, you said your sister has schizoaffective disorder and your son has disorganized schizophrenia and you can see the differences. My daughter was diagnosed by the first psychiatrist with disorganized schizophrenia and it was changed to schizoaffective disorder by her current doctor. She has never been bipolar and as to depression, doesn’t that pretty much go hand in hand with schizophrenia? The only other thing about her would probably be impulse control that keeps getting her in all sorts of legal problems. Can you please tell me the differences you saw in your sister and son? I think it may help me understand better what we may be dealing with concerning my daughter.

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My son’s emotions were flat affect, not much in the way of expressions for the most part and while he had a brief bout of depression when his illness was at it’s worst…the depression seemed to vanish for good once his voices and visions were brought under control and it hasn’t come back since. Today he still has some flat affect but occasionally will laugh at a joke, or a TV comedy but he often “misses” the humor too and I don’t think I have ever seen him cry.

My sister on the other hand, her emotions are literally all over the place. Sometimes I think she seems bi polar but not in the traditional sense…just that she gets very energetic sometimes and then she will be extremely exhausted for days (which kind of fits) Then she laughs and cries and even rages inappropriately. She does seem delusional sometimes, though but the delusions aren’t harmful other than making her stay homebound and stop communicating with others quite often…and she talks to God incessantly as if he is there…She does not get the right treatment but she has some treatment from her family doctor (they can deal with “anxiety issues” in many cases) So he prescribed her Buspar which helps a little to keep her minimally normalized but it’s just not consistent. I think she needs a stabilizer and at least a mild anti psychotic and I am working to convince her to go to a place that can help her with that. She often shuts me out though and communication is very difficult. Succeeding at anything with her can literally take years. It took me 2 years to get her to agree to have her dangerously rotted teeth (at the time) removed and have herself fitted for dentures, it was a traumatic experience for both of us (she was an emotional handful) After that fiasco was over she never wore the teeth again and refused to talk to me for 18 months…I know TMI sorry I get on a rant sometimes, I hope I answered your question if I didn’t let me know.

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I think this term is also given when there isn’t a true sign of schizophrenia for a consistent 6 months, diagnosis will change many more times as life goes on, that’s just the way it is when you go for different opinions

I would be concerned about a psych nurse who gave that definition. The DSM is very clear that it is an affective plus thought disorder. The NP should be very familiar with the Diagnostic and Statistical Manual, the “encyclopedia” of mental health. Now I could understand if she said that the “result” of having schizoaffective might be that antipsychotic meds are not sufficient alone to curb symptoms. That was the case with my sister, whose initial diagnosis was (correctly) schizophrenia, but she required AP plus Lithium to achieve stability. I think schizophrenia is very anxiety-provoking after a person is brought out of the disorganized/catatonic state by APs. However, my sister objected to the schizophrenia label and talked her psychiatrist into BiPolar type 1 (with psychotic features). Many years later another psychiatrist changed that to schizoaffective disorder. She has NEVER been able to function without APs due to delusions and paranoia. BTW, manic-depressive was the original name of the affective disorder and it was later changed to Bipolar.

That’s a great explanation about the meds. My son just got put on a mood stabilizer (Tegretal), and while it hasn’t even been a week yet, it’s made a remarkable difference.

I’m hoping it lasts - other things have made a remarkable difference & then gave out on him.

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In the NAMI Family to Family course, I learned that the diagnosis is less important than the treatment and getting the right meds is a crap shoot anyway for all these disorders. Don’t get hung up on it darling, good luck, you have your hands full xoxox

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My son was diagnosed with paranoid schizophrenia five years ago. He just got out from his second hospitalization and his discharge papers say paranoid schizophrenia and schizoaffective disorder, which I don’t really think is correct. He’s never been manic or depressed either. Anxiety, yes, but not depressed. And I have never heard of someone having BOTH. You know about schizophrenia, right? Schizoaffective is like having bipolar and schizophrenia at the same time, so it seems redundant to me to say schizophrenia and schizoaffective. It seems like it’s one or the other to me. Because of this, he’s on two more medications and more antipsychotic medication, the same but the next highest dose. I’m not too thrilled. I’ve been learning and studying schizophrenia! And I hate he’s on more medication! He’s only been home since Friday and I’ve been watching him adjust to the new medications. So I’m thinking tomorrow I need to call his doctor. Ugh!


You definitely deserve to have clarification from the doctor, I hope you get it, and if the doctor doesn’t clarify well enough, I think you could seek a second opinion if that is even a possibility.

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Yes, definitely get a second opinion. He either has schizophrenia OR schizoaffective disorder, but not both.

Psychiatric diagnoses are not like regular medical diagnoses. They’re very subjective rather than objective. They’re based on what he tells them, what they observe him do and what other people tell them about him. There is no blood test, CT scan, MRI, etc. that can be used to definitively diagnose schizophrenia, so, they are often wrong.

In the s.m.i. clinic where I attended group therapy for schizophrenics, I heard about how many of them were at first diagnosed with various other illnesses, such as bipolar, and later were diagnosed with schizophrenia or schizoaffective disorder. But they put us together in the same group therapy class-- schizophrenia and schizoaffective. But there was a separate group therapy class for bipolar. So, that tells me that schizophrenia and schizoaffective are far more similar than different.

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So it sounds weird to you, too?

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I agree. I don’t think it’s possible to have both. Yes, bipolar and schizophrenia, which is basically schizoaffective. I’m sure of his diagnosis of paranoid schizophrenia. Thanks for your input.