Schizo-Affective Disorder
This is my "main" disorder, the one that took the longest to diagnose, and the one whose treatment improved my life a thousandfold.  Once I went on anti-psychotic drugs, many of my problems all but disappeared (hearing voices, hearing God in my head, paranoia, irrational thoughts and beliefs).  Below is the NAMI (National Alliance for the Mentally Ill) fact sheet about schizoaffective disorder.  I've also included their information about schizophrenia and bipolar disorder, since schizoaffective disorder is somewhat of a cross between the two.
What is Schizoaffective Disorder?
Some psychiatric disorders are very difficult to diagnose accurately. One of the most confusing conditions is schizoaffective disorder.  This relatively rare disorder is defined as "the presence of psychotic symptoms in the absence of mood changes for at least two weeks in a patient who has a mood disorder." The diagnosis is used when an individual does not fit diagnostic standards for either schizophrenia or "affective" (mood) disorders such as depression and bipolar disorder (manic depression).
Some people may have symptoms of both a depressive disorder and schizophrenia at the same time, or they may have symptoms of schizophrenia without mood symptoms.
Many individuals with schizoaffective disorder are originally diagnosed with manic depression. If the person experiences delusions or hallucinations that go away in less than two weeks when the mood is "normal," bipolar disorder may be the proper diagnosis. Someone who experiences psychosis for three or four weeks while in a manic phase does not have schizoaffective disorder.
However, if delusions or hallucinations continue after the mood has stabilized and are accompanied by other symptoms of schizophrenia such as catatonia, paranoia, bizarre behavior, or thought disorders, a diagnosis of schizoaffective disorder may be appropriate. Accurate diagnosis is easier once the acute psychotic episode is under control.
Distinguishing between bipolar disorder and schizophrenia can be particularly difficult in an adolescent, since at that age psychotic features are especially common during manic periods.
Because schizoaffective disorder is so complicated, misdiagnosis is common. Some people may be misdiagnosed as having schizophrenia. Others may be misdiagnosed as having bipolar disorder. And those diagnosed as having schizoaffective disorder may actually have schizophrenia with prominent mood symptoms. Or they may have a mood disorder with symptoms similar to those of schizophrenia.
What is the treatment for this disorder?
Psychiatrists often treat this disorder with an anti-psychotic medication and lithium, or with carbamazepine (an anticonvulsant medication) and lithium.  As a practical matter, differentiating between schizophrenia, bipolar disorder, and schizoaffective disorder is not absolutely critical, since antipsychotic medication is recommended for all three. If a mood problem is suspected, lithium or an antidepressant should be added.
What is the prognosis for those with this disorder?
The prognosis for individuals diagnosed with schizoaffective disorder is generally better than for those diagnosed with schizophrenia, but not quite as good for those diagnosed with a mood disorder. (Schizophrenia is a chronic brain disorder interfering with a persons' ability to think clearly, manage emotions, make decisions, and relate to others. Persons with schizophrenia may experience hallucinations and delusions. Mood disorders, including depression and bipolar disorder, are chronic illnesses in which the person's mood may return to "normal" between depressive or manic episodes.) Those with schizoaffective disorder generally respond to lithium better than those with schizophrenia, but not as well as those with mood disorders. More research is needed to fully understand this illness and why it resists conventional treatment. New medications may be developed to treat this disorder more effectively.
Schizophrenia
What is schizophrenia?
Schizophrenia is a devastating brain disorder that affects approximately 2.2 million American adults, or 1.1 percent of the population age 18 and older. Schizophrenia interferes with a person's ability to think clearly, manage emotions, make decisions, and relate to others. The first signs of schizophrenia typically emerge in the teenage years or twenties. Most people with schizophrenia suffer chronically or episodically throughout their lives, and are often stigmatized by lack of public understanding about the disease. Schizophrenia is not caused by bad parenting or personal weakness. A person with schizophrenia does not have a "split personality," and almost all people with schizophrenia are not dangerous or violent towards others when they are receiving treatment.
What are the symptoms of schizophrenia?
No one symptom positively identifies schizophrenia. All of the symptoms of this illness can also be found in other brain disorders. For example psychotic symptoms may be caused by the use of drugs, or may be characteristics of a manic episode in bipolar disorder. However, when a doctor sees the symptoms of schizophrenia and carefully assess the course of the illness over six months, he or she can almost always make a correct diagnosis.
The symptoms of schizophrenia are generally divided into three categories, including positive, disorganized and negative symptoms.
Positive Symptoms, or "psychotic" symptoms, include delusions and hallucinations because the patient has lost touch with reality in certain important ways. "Positive" as used here does not mean "good." Rather, it refers to having overt symptoms that should not be there. Delusions cause the patient to believe that people are reading their thoughts or plotting against them, that others are secretly monitoring and threatening them, or that they can control other people's minds. Hallucinations cause people to hear or see things that are not there.
Disorganized Symptoms include confused thinking and speech, and behavior that does not make sense. For example, people with schizophrenia sometimes have trouble communicating in coherent sentences or carrying on conversations with others; move more slowly, repeat rhythmic gestures or make movements such as walking in circles or pacing; and have difficulty making sense of everyday sights, sounds and feelings.
Negative Symptoms include emotional flatness or lack of expression, an inability to start and follow through with activities, speech that is brief and lacks content, and a lack of pleasure or interest in life. "Negative" does not, therefore, refer to a person's attitude, but to a lack of certain characteristics that should be there.
What are the causes of schizophrenia?
Scientists still do not know the specific causes of schizophrenia, but research has shown that the brains of people with schizophrenia are different, as a group, from the brains of people without the illness. Like many other medical illnesses such as cancer or diabetes, schizophrenia seems to be caused by a combination of problems including genetic vulnerability and environmental factors that occur during a person's development.
How is schizophrenia treated?
While there is no cure for schizophrenia, it is a highly treatable and manageable illness. However, people may stop treatment because of medication side effects, disorganized thinking, or because they feel the medication is no longer working. People with schizophrenia who stop taking prescribed medication are at a high risk of relapse into an acute psychotic episode.
Hospitalization. People who experience acute symptoms of schizophrenia may require intensive treatment including hospitalization. Hospitalization is necessary to treat severe delusions or hallucinations, serious suicidal thoughts, an inability to care for oneself, or severe problems with drugs or alcohol.
Medication. The primary medications for schizophrenia are called antipsychotics. Antipsychotics help relieve the positive symptoms of schizophrenia by helping to correct an imbalance in the chemicals that enable brain cells to communicate with each other. As with drug treatments for other physical illnesses, many patients with severe mental illnesses may need to try several different antipsychotic medications before they find the one, or the combination of medications, that works best for them.
Conventional Antipsychotics were introduced in the 1950's and all had similar ability to relieve the positive symptoms of schizophrenia. Most of these older "conventional" antipsychotics differed in the side effects they produced. These conventional antipsychotics include chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril).
New "Atypical" Antipsychotics. In the last decade new "atypical" antipsychotics have been introduced. Compared to the older "conventional" antipsychotics these medications appear to be equally effective for helping reduce the positive symptoms like hallucinations and delusions - but may be better than the older medications at relieving the negative symptoms of the illness, such as withdrawal, thinking problems, and lack of energy. The atypical antipsychotics include risperidone (Risperdal), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon).
Current treatment guidelines recommend using one of the atypical antipsychotics other than clozapine as a first line treatment option for newly diagnosed patients. However, for people already taking a conventional antipsychotic medication that is working well, a change to an atypical may not be the best option. People thinking of changing their medication should always consult with their doctor and work together to develop the most safe and effective treatment plan possible.
Psychosocial Rehabilitation. Research shows that people with schizophrenia who attend structured psychosocial rehabilitation programs and continue with their medical treatment manage their illness best. One of the most effective psychosocial approaches for the most severely ill or those with both mental illness and substance abuse, is the Program for Assertive Community Treatment (PACT), an intensive team effort in local communities to help people stay out of the hospital and live independently. Available 24-hours a day, seven-days a week, PACT professionals meet their clients where they live, providing at-home support at whatever level is needed. Professionals work with clients to address problems effectively, to make sure medications are being properly taken, and to meet the routine daily challenges of life, such as grocery shopping and managing money.
PACT programs are statewide in four states and growing in another 20 states. PACT is significantly reducing hospital admissions, and improving functioning and the quality of life for people with schizophrenia.
What are the side effects of the medications used to treat schizophrenia?
All medications have side effects. Different medications produce different side effects, and people differ in the amount and severity of side effects they experience. Side effects can often be treated by changing the dose of the medication, switching to a different medication, or treating the side effect directly with an additional medication. Common inconvenient side effects of all antipsychotic drugs used to treat schizophrenia include dry mouth, constipation, blurred vision, and drowsiness. Some people experience sexual dysfunction or decreased sexual desire, menstrual changes, and significant weight gain. Other common side effects relate to muscles and movement problems. These side effects include: restlessness, stiffness, tremors, muscle spasms, and one of the most unpleasant and serious side effects, a condition called tardive dyskinesia.
Tardive dyskinesia is a movement disorder where there are uncontrolled facial movements and sometimes jerking or twisting movements of other body parts. This condition usually develops after several years of taking antipsychotic medications and more predominantly in older adults. Tardive dyskinesia affects 15 to 20 percent of people taking conventional antipsychotic medications. The risk of developing tardive dyskinesia is lower for people taking the newer antipsychotics. Tardive dyskinesia can be treated with additional medications or by lowering the dosage of the antipsychotic if possible. For additional information see our fact sheet about tardive dyskinesia.
Clozapine was the first atypical antipsychotic in the United States and seems to be one of the most effective medications, particularly for people who have not responded well to other medications. However, in some people it has a serious side effect of lowering the number of white blood cells produced. People taking clozapine must have their blood monitored every one or two weeks to count the number of white blood cells in the bloodstream. For this reason clozapine is usually the last atypical antipsychotic prescribed, and is usually used as a last line treatment for people that do not respond well to other medications or have frequent relapses.
Bipolar Disorder
What is bipolar disorder?
Bipolar disorder, or manic depression, is a serious brain disorder that causes extreme shifts in mood, energy, and functioning. It affects 2.3 million adult Americans, or 1.2 percent of the population. Bipolar disorder is characterized by episodes of mania and depression that can last from days to months. Bipolar disorder is a chronic condition with recurring episodes that often begin in adolescence or early adulthood. It generally requires ongoing treatment.
What are the symptoms of mania?
Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:
What are the symptoms of depression?
Depression is the other phase of bipolar disorder. The symptoms of depression may include:
What is a "mixed" state?
A mixed state is when symptoms of mania and depression occur at the same time. During a mixed state depressed mood accompanies manic activation. The symptoms during a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking.
What is rapid cycling?
Sometimes individuals may experience regularly alternating periods of mania and depression. When four or more episodes of illness occur within a 12-month period, the individual is said to have bipolar disorder with rapid cycling. Rapid cycling is more common in women.
What are the causes of bipolar disorder?
While the exact cause of bipolar disorder is not known, researchers believe it is the result of a chemical imbalance in the certain parts of the brain. Scientists have found evidence of a genetic predisposition to the illness. Bipolar disorder tends to run in families, and close relatives of someone with bipolar disorder are more likely to be affected by the disorder. Sometimes serious life events such as a serious loss, chronic illness, or financial problem, can trigger an episode in some individuals with a predisposition to the disorder. There are other possible "triggers" of bipolar episodes: the treatment of depression with an antidepressant medication may trigger a switch into mania, sleep deprivation may trigger mania, or hypothyroidism may produce depression or mood instability. It is important to note that bipolar episodes can also occur without an obvious trigger.
How is bipolar disorder treated?
While there is no cure for bipolar disorder it is a highly treatable and manageable illness. After an accurate diagnosis, most people (80 to 90 percent) can be successfully treated. Medication is an essential part of successful treatment for people with bipolar disorder. Maintenance treatment with a mood stabilizer substantially reduces the number and severity of episodes for most people, although episodes of mania or depression may occur and require a specific additional treatment. In addition, psychosocial therapies including, cognitive-behavioral therapy, interpersonal therapy, family therapy, and psychoeducation are important to help people understand the illness and cope with the stresses that can trigger episodes. Changes in medications or doses may be necessary, as well as changes in treatment plans during different stages of the illness.
Medications used to treat mania. Two medications commonly used to treat manic episodes of bipolar disorder are called mood stabilizers, and they include lithium (Eskalith or Lithobid) and divalproex sodium (Depakote).
Lithium has long been used as a first line treatment for acute mania in people with bipolar disorder. Lithium is effective for preventing episodes of mania from occurring and for treating an episode after it has begun. However, for some individuals, lithium is ineffective and for others, lithium has a variety of side effects that may make it an undesirable treatment option.
Depakote is an anticonvulsant that has been used to treat epilepsy since 1983, but it was approved as a treatment for manic episodes of bipolar disorder in 1995. Depakote seems to be as effective as lithium for treating mania and it has fewer side effects, although it may not be appropriate for people with a history of liver problems.
Other anticonvulsant medications have also been found to be effective treatments for mania, including carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin), and topiramate (Topamax). However, these four medications have not been officially approved by the FDA for the treatment of bipolar disorder and have their own side effects.
Mania may also be treated acutely with antipsychotic medications in addition to a mood stabilizer. More research is needed to test the safety and efficacy of atypical antipsychotics, which may prove to be alternatives in the long-term treatment of bipolar disorder.
Medications used to treat depression. During depressive episodes, people with bipolar disorder may need additional treatment with an antidepressant medication. Because of the risk of triggering mania, doctors often prescribe lithium or an anticonvulsant mood stabilizer with an antidepressant. Antidepressant medications relieve depression, elevate mood, and activate behavior, but it often takes three to four weeks to respond. Sometimes a variety of different antidepressants and doses will be tried before finding the medication that works best for a particular individual.
There are several different types of antidepressants used to treat depression including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), or newer antidepressants that function in different ways.
Consumers and their families must be cautious during the early stages of treatment when energy levels and the ability to take action return before mood improves. At this time - when decisions are easier to make, but depression is still severe - the risk of suicide may temporarily increase.
What are the side effects of the medications used to treat bipolar disorder?
All medications have side effects. Different medications produce different side effects, and people differ in the amount and severity of side effects they experience. Side effects can often be treated by changing the dose of the medication, switching to a different medication, or treating the side effect directly with an additional medication.
Side effects of medications used to treat mania. Lithium tends to have the most side effects of the mood stabilizers - including hand tremors, excessive thirst, excessive urination, and memory problems - but they often become less troublesome after a few weeks as the body adjusts to the medication. Particularly bothersome tremors can be treated with additional medication. Low thyroid function can be treated with thyroid supplements. In very few people, long-term lithium treatment can interfere with kidney function.
The other anticonvulsant mood stabilizers tend to have fewer side effects than lithium. Common side effects include nausea, drowsiness, dizziness, and tremors. Some people taking anticonvulsant mood stabilizers may develop liver problems or problems with white blood cell count and blood platelets, which can be severe. Therefore, blood tests to monitor liver function and blood cells may be an important part of treatment with some of these medications.
Side effects of medications used to treat depression. About half of the people taking antidepressant medications have mild side effects during the first few weeks of treatment.
Common side effects of tricyclic antidepressants (TCAs) include dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash, or weight gain or loss.
Individuals taking monoamine oxidase inhibitors (MAOIs) may have to be careful about eating certain smoked, fermented, or pickled foods, drinking certain beverages, or taking some medications because they can cause severe high blood pressure in combination with the medication. MAOIs have other, less severe side effects as well.
The SSRIs and newer antidepressants tend to have fewer and different side effects, such as nausea, nervousness, insomnia, diarrhea, rash, agitation, or sexual problems.
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