The diagnosis of schizoaffective disorder is based on the assessment of an uninterrupted period of illness during which the individual continues to display active or residual symp- toms of psychotic illness. The diagnosis is usually, but not necessarily, made during the period of psychotic illness. At some time during the period, Criterion A for schizophrenia has to be met. Criteria B (social dysfunction) and F (exclusion of autism spectrum disorder or other communication disorder of childhood onset) for schizophrenia do not have to be met. In addition to meeting Criterion A for schizophrenia, there is a major mood episode (major depressive or manic) (Criterion A for schizoaffective disorder). Because loss of in- terest or pleasure is common in schizophrenia, to meet Criterion A for schizoaffective dis— order, the major depressive episode must include pervasive depressed mood (i.e., the presence of markedly diminished interest or pleasure is not sufficient). Episodes of de- pression or mania are present for the majority of the total duration of the illness (i.e., after
Criterion A has been met) (Criterion C for schizoaffective disorder). To separate schizoaf- fective disorder from a depressive or bipolar disorder with psychotic features, delusions or hallucinations must be present for at least 2 weeks in the absence of a major mood epi— sode (depressive or manic) at some point during the lifetime duration of the illness (Cri- terion B for schizoaffective disorder). The symptoms must not be attributable to the effects of a substance or another medical condition (Criterion D for schizoaffective disorder).
for a major mood episode must be present for the majority of the total duration of the ac- tive and residual portion of the illness. Criterion C requires the assessment of mood symp- toms for the entire course of a psychotic illness, which differs from the criterion in DSM-IV, which required only an assessment of the current period of illness. If the mood symptoms are present for only a relatively brief period, the diagnosis is schizophrenia, not schizoaf- fective disorder. When deciding whether an individual’s presentation meets Criterion C, the clinician should review the total duration of psychotic illness (i.e., both active and re- of treatment with antidepressant and / or mood-stabilizing medication) accompanied the psychotic symptoms. This determination requires sufficient historical information and clinical judgment. For example, an individual with a 4-year history of active and residual symptoms of schizophrenia develops depressive and manic episodes that, taken together, do not occupy more than 1 year during the 4-year history of psychotic illness. This presen- tation would not meet Criterion C.
In addition to the five symptom domain areas identified in the diagnostic criteria, the assessment of cognition, depression, and mania symptom domains is vital for making crit- ically important distinctions between the various schizophrenia spectrum and other psy- chotic disorders.
Occupational functioning is frequently impaired, but this is not a defining criterion (in contrast to schizophrenia). Restricted social contact and difficulties with self—care are as- sociated with schizoaffective disorder, but negative symptoms may be less severe and less persistent than those seen in schizophrenia. Anosog-nosia (i.e., poor insight) is also com- mon in schizoaffective disorder, but the deficits in insight may be less severe and perva- sive than those in schizophrenia. Individuals with schizoaffective disorder may be at increased risk for later developing episodes of major depressive disorder or bipolar disor- der if mood symptoms continue following the remission of symptoms meeting Criterion A for schizophrenia. There may be associated alcohol and other substance-related disorders.