Table of ContentsDiagnosing Schizoaffective DisorderC.WZ Case Study of Schizoaffective DisorderPossible Treatment ModalitiesDiagnosing Schizoaffective Disorderaccording to the Diagnostic and Statistical Manual of Mental Health (5th ed.; DSM-5; American Psychiatric Association [APA], 2013), to receive a diagnosis of schizophrenia, one must experience at least one symptom of these three: delusions, hallucinations, or disorganized speech. They must then experience at least two of these five symptoms: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior and negative symptoms (APA, 2013). To go further, they must experience these symptoms for at least six months (APA, 2013). Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”?Get the original essaySchizophrenia affects only about 1% of the world's population according to UpToDate (Fischer and Marder, 2018). This is particularly difficult to measure because different cultures recognize and categorize mental health disorders differently. This disorder affects men slightly more than women and generally appears during adolescence (Fischer and Marder, 2018). The diagnosis of bipolar I disorder requires the individual to meet certain criteria, and the following criteria constitute what constitutes a manic episode. According to the DSM-5, Criterion A states that a manic episode must include a distinct period of at least one week during which the person experiences an abnormally elevated or irritable mood (APA, 2013). This will include a jump in energy and/or activity, and will occur almost daily (APA, 2013). Criterion B states that the mood change must result in at least three of the following significant behavioral changes: inflated or grandiose self-esteem, decreased need for sleep, more talkative than usual, volatile ideas or racing thoughts , distraction, more attention to the goal. directed activities, time and abnormal thinking spent on activities with potentially negative consequences such as gambling and unsafe sexual encounters (APA, 2013). Criterion C includes the existence of psychotic features or a mood change severe enough to impair the individual's ability to function socially and professionally, or require hospitalization to avoid harm to themselves or others. harm to others (APA, 2013). Criterion D adds that none of the preceding phenomena can be caused by another condition or by substances such as medications or treatments (APA, 2013). According to the UpToDate article titled “Bipolar Disorder in Adults: Epidemiology and Pathogenesis,” bipolar disorder affects between 1 and 3 percent of the world's population. This disorder affects men and women equally, and the average age of onset for bipolar I disorder is 18 years old, while the average age of onset for bipolar II disorder is 20 years old (Stovall, 2018). Schizoaffective disorder affects only 0.3%. of the world's population and is therefore about a third less than schizophrenia ("National Alliance on Mental Health", 2018). This disorder bridges the gap between schizophrenia and bipolar disorder. According to the DSM-5, one must experience at least two of the symptoms characteristic of a schizophrenic, then also have a major mood episode (mania or depression that lasts for an uninterrupted period), delusions or hallucinations for more than two . weeks without mood symptoms and mood symptoms present in the majority of cases (which cannot be caused by substance abuse) (APA, 2013). Schizoaffective disorder is essentially a mixture ofschizophrenia and bipolar disorder, so it can be quite difficult to diagnose. Individuals may be initially diagnosed as having one or the other based on their most prevalent symptoms. Due to the delusions and/or hallucinations they may experience, they may appear extremely paranoid and anxious. Peers may view many of their thoughts, beliefs, and actions as totally out of character and completely disorganized. They can engage in religion and be completely absorbed in it. Aside from the extremes, it is common for these individuals to appear apathetic and confused. The bipolar characteristics of this disorder will place the person in a manic or depressive state. In a manic state, they appear quite euphoric and may view themselves as superior to others. They may think they are very rich, have high status, or are extraordinarily intelligent. They may have rapid speech, racing thoughts, insomnia, and rage. In a depressed state, they may feel tired and sad almost constantly. They may have suicidal thoughts, difficulty concentrating, loss of appetite, and the desire to perform all daily activities. Most often, a person with schizoaffective disorder will primarily experience symptoms of psychosis before symptoms of a mood disorder begin to appear. This is different from a bipolar person who will only show symptoms of psychosis when there is a change in mood. Because most individuals will be diagnosed with schizophrenia or bipolar disorder before receiving a diagnosis with schizoaffective disorder, little is known about illness trends across the lifespan. Sometimes looking at the onset of schizophrenia and bipolar disorder is enough, as either or both symptoms will appear early. Not much is known about the cause of schizoaffective disorder. Some studies seem to suggest that there is most likely a genetic component. The combination of various genes over time could in this case constitute a mental illness. “These genes are thought to include some that regulate the body's daily rhythms, such as the sleep-wake cycle; others that help control the movement of nerve cells during brain development; and others involved in sending and receiving chemical signals in the brain ("Schizoaffective Disorder - Genetics Home Reference", 2018). Genes involved in making GABA neurotransmitter receptors could also be associated. A person is more likely to get this disorder if a first-degree relative has the disorder (“Schizoaffective Disorder – Genetics Home Reference,” 2018). Mental health diagnoses differ across cultures. In the past, even the DSM has struggled with diagnostic criteria for schizoaffective disorder. The first two versions of the DSM considered schizoaffective psychosis to be a subtype of schizophrenia comprising both psychotic and affective features (Wilson, Nian, & Heckers, 2013). Since the diagnosis of “schizoaffective disorder” is still being developed among professionals, it is more relevant to discuss the cultural associations between schizophrenia and bipolar disorder. According to the article titled “Cultural Aspects of Major Mental Disorders: A Critical Review from the Indian Perspective, schizophrenia is less prevalent in developing countries; however, this is most likely due to underreporting (Viswanath & Chaturvedi, 2012). Some illnesses may not always be defined differently by healthcare professionals.health across the world, but many may go unreported. This may be because they are not concerned, because they are afraid of being excluded, or perhaps because they do not know that anything can be done about it. Interestingly, during some religious ceremonies it is normal to hear voices that others cannot hear. This just goes to show that in some cultures it can be perfectly acceptable to hear voices; However, these people may not know that when these voices continue, it could actually be a sign of mental illness rather than spiritual awakening. CWZ Case Study on Schizoaffective Disorder C.WZ is a 48-year-old Caucasian male. In his medical history, he had been diagnosed with schizophrenia; However, after being admitted to the mental health units for short periods at Porter Hospital in May, Aurora North Hospital in June and most recently at Denver Health in July, doctors had the chance to explored his symptoms further and have since changed this diagnosis. to schizoaffective disorder, bipolar type. CWZ presented to Denver Health complaining of right leg pain and was treated for cellulitis. He then returned a day later due to persistent pain and, after further assessment, was admitted to the mental health unit for extreme psychosis. He had not followed his discharge instructions from Porter Hospital when admitted to Aurora North and it quickly became apparent that he had not followed his new outpatient care plan either. Not only did CWZ need help with medication adherence, but he also needed help with personal care and basic safety. As part of a diagnosis of schizophrenia, this individual's thoughts were disorganized, he had problems with cognition, memory judgment, and impulse control. He also presented with severe clinical manifestations such as hallucinations, delusions, mania, acute psychosis, extreme agitation, and anxiety. Among other things, the presence of mania and agitation makes its diagnosis different from schizophrenia. He clearly demonstrated racing thoughts through his running speech, he displayed grandiose behaviors, slept very little, and was very easily distracted. These symptoms of schizophrenia as well as bipolar mania are the basis for the diagnosis of schizoaffective disorder in this patient. After spending about two hours with the patient in Denver Health's mental health unit, specific examples emerged that reinforced this diagnosis quite accurately. CWZ was living with his mother at the time of his admission, but in some of his accounts he claimed to have been homeless in the recent past. CMZ explains that he has a degree in technology design and that every time he tries to find a job in that field, the employer is threatened by his talent and finds a way to botch his job. He said if he could get a job it would be building lasers and robots. He would then use these lasers to make furniture like at Ikea. It was not surprising that he moved from job to job, as he told many stories of paranoia that his co-workers were trying to poison him. In most cases, they poisoned the rim of his soda, which he considered completely normal. He said that when he leaves Denver Health, he will pick up his laser from his friend so he can sell it for a new car. He said this friend was stealing his old car and driving 20 miles every night. He also loved talking about how he did engineering design forgreat rock bands. CMZ jumped from story to story quickly and it was very difficult to decipher where one story ended and another began. These are just a few examples of his delusions, disorganized and rushed speech, and grandiose thoughts. Before arriving at Denver Health, CMZ had already been prescribed lorazepam for anxiety, zaleplon for insomnia, cariprazine for schizophrenia and bipolar mania, clonazepam for anxiety, lamotrigine for bipolar disorder, primidone for seizures, seroquel for schizophrenia, bipolar disorder and major depressive disorder, and ambien for insomnia, among other medications such as laxatives. These eight medications were prescribed for schizoaffective disorder. Some were for psychosis, others for mania, and still others for anxiety and insomnia. Although these medications may have been effective enough to warrant a discharge order from Aurora North, CMZ was completely noncompliant during his short time out of the hospital and so Denver Health doctors decided to go to another direction. All of CMZ's previous medications were stopped and he started taking atarax for various reasons such as anxiety, insomnia and irritability, zyprexa for schizophrenia and bipolar mania, and lithium for bipolar disorder, among other medications such as antibiotics. No mental health-related medication was continued. It was a clean slate for both doctors and patients. This was a significant reduction in the number of medications and, although some of them are very similar, it was a bold choice to start a new one. Three days after being treated with this new drug regimen, CMZ began to show signs of improvement, although his treatment required much more time to see the full effects.Possible Treatment ModalitiesThe dominant method of treating disorders such as Schizoaffective disorder is accompanied by a multitude of various medications. Unfortunately, with a patient population that is already struggling with their mental abilities, once they leave the facility it is often difficult for them to maintain such a strict regimen. If mental health conditions could be treated with just one medication rather than ten, it would be much more likely that the patient would continue their care after discharge. Patients with schizoaffective disorder are usually prescribed medications specific to their symptoms; as with CMZ, who was individually prescribed mood stabilizers, anxiolytics, antipsychotics, sedatives, etc. In a 2015 study published in the "Journal of Affective Disorders," Fu, Turkoz, Bossie, Patel, and Alphs state that "more recently, large, well-controlled clinical trials of oral paliperidone extended-release (pali ER), administered in monotherapy or in combination with mood stabilizers and/or antidepressants, helped establish the drug as a safe, effective, acute treatment for [schizoaffective disorder]” (p. 381). This study included 614 schizoaffective patients (depressive or manic) divided into two groups. One group received 6 mg per day (the amount could be adjusted after 3 days) of pali ER and one group received a placebo. All other medications were discontinued appropriately. Using PANSS, HAM-D-21 AND YMRS scores, patients were analyzed after 4 days, then after 1, 2, 3, 4 and 6 weeks. Patients with schizoaffective disorder who have experienced depression or mania tend to see significant improvement with pali ER within the first week of treatment.