Schizophrenia and Schizoaffective Disorder: How They Compare
Schizoaffective disorder and schizophrenia differ, including in remission rates.
Schizoaffective disorder is often mistaken for schizophrenia.
Schizophrenia and schizoaffective disorder are distinguished from each other by type of affect.
Patients with schizoaffective disorder are more likely to experience remission than those with schizophrenia.
Advocating for rights for people with schizophrenia is a tough lifestyle. In fact, there are only a handful of activists in the United States who have successfully executed writing a memoir, starting a YouTube channel, and gathering a following.
What is less spoken about is that these activists often do not exactly have a schizophrenia diagnosis in the true sense. Many of us advocating for schizophrenia education have schizoaffective disorder instead.
It is easy to conflate the two because both disorders display classic symptoms of psychosis: delusions, word salads, and hallucinations, to name a few. But the two differ primarily on one distinction: Schizoaffective disorder comes with the debilitating effect of extreme moods, and schizophrenia often results in a lack of affect, or mood.
Schizoaffective disorder’s mood categorization is based on whether or not the patient is exhibiting either depression episodes or both mania and depression symptoms, resulting in either Schizoaffective Disorder Type I or Type II. A patient will get diagnosed with schizoaffective disorder rather than bipolar disorder with psychotic symptoms when the patient experiences psychotic symptoms outside of the manic and depressive episodes. Psychosis in bipolar is more of an effect of the moods, while psychotic symptoms in schizoaffective disorder are the primary debilitating factor.
What the Research Says About Recovery
So why does it seem like people with schizoaffective disorder are more public and seemingly better in prognosis than people with schizophrenia? Some studies have looked into this issue.
In Italy in 2014, for example, researchers looked into remission and recovery rates in patients with schizophrenia and patients with schizoaffective disorder. Participants included 102 people: 46 diagnosed with schizophrenia and 66 with schizoaffective disorder.
What they found was that schizoaffective disorder was more commonly diagnosed in females, while schizophrenia patients were more often male. The percentage of those in remission (which is when symptoms become less severe) was higher in those with schizoaffective disorder than those with schizophrenia. Patients with schizoaffective disorder had a statistically significant rate of 42.4 percent of patients in remission compared to 23.9 percent of individuals with schizophrenia.
Recovery was also better for individuals with schizoaffective disorder than for individuals with schizophrenia. Those rates that were statistically significant were 22.7 percent of schizoaffective patients versus 6.5 percent of schizophrenia patients.
A similar percentage of patients were placed on the same first-generation antipsychotics (33.3 percent of schizoaffective patients and 34.8 percent of schizoaffective patients), while 73.9 percent of schizophrenia patients and 78.8 percent of schizoaffective patients were put on second-generation antipsychotics (which are thought to be more effective with fewer side effects), which shows many were treated with the same methods. People with schizoaffective disorder were more often prescribed benzodiazepines (like Xanax and Klonopin) and mood stabilizers.
The researchers were puzzled about why this was but speculated that schizoaffective patients have more mood components, which could somehow affect prognosis. Additionally, studies conducted in other countries—for instance, in Israel—reported unreliable diagnoses of schizoaffective disorder throughout time. People with schizoaffective disorder were more likely to be misdiagnosed and have their diagnosis changed compared to people who received the diagnosis of schizophrenia.
Schizoaffective disorder remains a controversial diagnosis, and because it is commonly misattributed to patients it can be difficult to determine how truly distinct it is as a diagnosis when the patient can easily fit many criteria for other disorders.
It is clear that patients who have schizophrenia differ in fundamental ways from those who have schizoaffective disorder. How those differences are explained is currently unknown, but statistical rates of recovery indicate that there are some reasons why people with schizoaffective disorder more frequently recover and experience remission.
Sarah An Myers
References
Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016.
Pinna, F., Sanna, L., Perra, V., Randaccio, R. P., Diana, E., Carpiniello, B., & Cagliari Recovery Study Group. (2014). Long-term outcome of schizoaffective disorder. Are there any differences with respect to schizophrenia? Rivista di psichiatria, 49(1), 41-49.
Florentin, S., Reuveni, I., Rosca, P., Zwi-Ran, S. R., & Neumark, Y. (2023). Schizophrenia or schizoaffective disorder? A 50-year assessment of diagnostic stability based on a national case registry. Schizophrenia Research, 252, 110-117.
