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Schizoaffective disorder

  • David J. Castle

Summary

The term ‘schizoaffective disorder’ has meant different things to different people over the 80 years since Kasanin described a series of cases with an admixture of schizophrenia-like and mood-like symptoms. This article provides a brief overview of the history of the concept, and suggests a parsimonious approach for clinicians.

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Copyright

Corresponding author

Professor David Castle, Department of Psychiatry, St Vincent's Hospital, University of Melbourne, Level 2, 46 Nicholson Street, Fitzroy, VIC 3065, Australia. Email: d.castle@svhm.org.au

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Declaration of Interest

None.

Footnotes

References

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American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). APA.
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). APA.
Bertelsen, A, Gottesman, II (1995) Schizoaffective disorder: clues to classification. American Journal of Medical Genetics 60: 711.
Jager, M, Bottlender, R, Strauss, A et al (2004) Fifteen-year follow-up of ICD-schizoaffective disorders compared to schizophrenia and affective disorders. Acta Psychiatrica Scandinavica 109: 30–7.
Kasanin, J (1933) The acute schizoaffective psychoses. American Journal of Psychiatry 90: 97126.
Kendell, RE, Brockington, IF (1980) The identification of disease entities and the relationship between schizophrenic and affective psychoses. British Journal of Psychiatry 137: 324–31.
Kendell, RE (1988) Other functional psychoses. In Companion to Psychiatric Studies (eds Kendell, RE, Zealey, AK) 362–73. Churchill Livingstone.
Kendler, KS, McGuire, M, Gruenberg, AM et al (1995) Examining the validity of DSM-III-R schizoaffective disorder and its putative subtypes in the Roscommon Family Study. American Journal of Psychiatry 152: 755–64.
Kraepelin, E (1921) Manic-depressive insanity and paranoia. In Psychiatrie, ein Lehrbuch für Studierende und Ärzte (8th edn) (trans Barclay, RM). Churchill Livingstone.
Levitt, JJ, Tsuang, MT (1988) The heterogeneity of schizoaffective disorder: implications for treatment. American Journal of Psychiatry 145: 926–36.
Sampson, JA, Simpson, JC, Tsuang, MT (1988) Outcome of schizoaffective disorders. Schizophrenia Bulletin 14: 543–54.
World Health Organization (1992) The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). WHO.

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Schizoaffective disorder

  • David J. Castle

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Schizoaffective disorder

  • David J. Castle
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eLetters

Model of multiple diagnostic entities may fit schizoaffective disorder better to nosology

Partha Sarathi Biswas, Psychiatrist
16 May 2012

Castle DJ (2012) has addressed the very topical subject of 'schizoaffective disorder'. Because of their low reliability and questionable validity, there is need for a revision of the current diagnostic concepts of schizoaffective disorder. Future developments in ICD-1 and DSM-5 are unclear. How we might see this disorder in future nosology would be an interesting area of discussion. Psychiatric nosology can be conceptualised in terms of three models: Kraepelin's dichotomous approach, the dimensional diagnostic approach and the multiple diagnostic approach.

A dichotomous classification of non-organic psychoses is not compatible with recent neurobiological findings. Furthermore, studies of psychopathological symptoms have also failed to confirm the dichotomous classification. Rather, they point to a continuous-spectrum model of functional psychoses using a more dimensional diagnostic approach. However, at this point, switching from a categorical classification to a purely dimensional model entails hazards in clinical practice because current treatment guidelines are based on categorical diagnoses, and the psychopathological syndrome dimensions have low stability in the long-term course of the illness. Thus, a subdivision of classic categories into multiple diagnostic entities is an alternative option. Here, distinct etiological factors, psychopathological characteristics, neuropathological findings and outcomes can be entertained simultaneously.

Further, one can classify non-organic psychoses on the basis of course and outcome, which might improve the individual treatment of psychiatric disorders. Following Kasanin's original concept, future diagnostic systems could try to establish reliable criteria for schizoaffective disorder that predict a favorable outcome and allow a differentiation from chronic schizophrenic disorders. However, it would be interesting to see the relationship of schizoaffective disorder to brief and acute psychoses. Some authors have argued against this approach because distinct categories for remitting psychoses such as schizoaffective disorders could contribute to increasing the stigma of schizophrenia.

The forthcoming ICD-11 and DSM-5 might follow a 'triaxial' classification similar to one proposed by Essen-Moller (1962). Jager et al (2008) speculated that they will introduce the complementary use of dimensional and categorical concepts. A dimensional concept can be helpful in describing the cross-sectional clinical picture, whereas a categorical approach can specify course and outcome. Psychopathological course types can be considered as prototypes within a continuous biological spectrum of schizophrenic and affective disorders. An additional 'axis' could comprise information about etiology. Many authors (e.g. Lake and Hurwitz 2007; Malhi et al 2008) propose the omission of the current concept of schizoaffective disorder from ICD-11 and DSM-5. Thus, a model of multiple diagnostic entities may be compatible with retaining the diagnostic category of schizoaffective disorder in the nosology.

References

Castle SJ (2012). Schizoaffective disorder. Advances in psychiatric treatment 18: 32-33.

Essen-Moller E (1962). On classification of mental disorders. Acta Psychiatr Scand 37:119-26.

Jager M, Frasch K, Becker T (2008). New ways in psychiatric diagnostics? Fortschr Neurol Psychiatr 76:186-293.

Lake CR, Hurwitz N (2007). Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease - there is no schizoaffective disorder. Curr Opin Psychiatry 20:365-79.

Malhi GS, Green M, Fagiolini ED, et al (2008). Schizoaffective disorder: diagnostic issues and further recommendations. Bipolar Disord 10:215-30.

Authors:

Dr.Partha Sarathi Biswas* [1], Ms. Devosri Sen [2]

Address:

1.Senior Resident, Department of Psychiatry, Ranchi Institute of Neuro- Psychiatry and Allied Sciences (RINPAS), Kanke, Ranchi, India;

2.PhD Scholar, Department of Clinical Psychology, Central Institute of Psychiatry (CIP), Kanke, Ranchi, India

* Corresponding author

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Conflict of interest: None declared

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