Schizoaffective Disorder vs. Schizophrenia: Symptoms, Causes, Treatment

Key Takeaways

• Schizoaffective disorder includes mood symptoms like depression or bipolar episodes alongside schizophrenia symptoms.
• In schizophrenia, mood episodes like depression or mania do not last throughout the illness.
• Both disorders can be managed with treatment, and the prognosis for schizoaffective disorder is better than for schizophrenia.

Knowing the differences between schizoaffective disorder vs. schizophrenia can be difficult, especially since both include the core psychotic symptoms of hallucinations, delusions, and disorganized thinking. However, they are two different disorders, each with its own diagnostic criteria and treatment.

For instance, prominent mood features are required for the diagnosis of schizoaffective disorder but not for the diagnosis of schizophrenia. Learn more about key differences in schizoaffective disorder vs. schizophrenia, including those related to their symptoms, causes, diagnosis, and treatment.

If you are concerned that you may have one of these psychological disorders, consult a healthcare provider for appropriate diagnosis and treatment.

Symptoms in Common

In both schizoaffective disorder and schizophrenia, all of the diagnostic criteria for schizophrenia are met and include the following symptoms:

Hallucinations are false sensory perceptions and include hearing voices, seeing images, or feeling sensations that are not there.

Delusions are false beliefs, such as thinking that people are visiting through time travel or that a person is secretly disguised as someone else.

Disorganized thoughts and speech include unusual, illogical, or disconnected thoughts that make it difficult to communicate ideas coherently.

Negative symptoms: things that tend to decrease in someone experiencing a psychotic episode, including lowered feelings of pleasure, flattened emotional responses, withdrawal, and difficulty with self-care.

With each of these disorders, the person also lacks insight into these perceptual problems and false beliefs.

For both conditions, the symptoms also usually begin when a person is between the ages of 16 and 30, and oftentimes, there is a family history of schizophrenia, bipolar disorder, or other illness with psychotic features.

Symptoms that Distinguish These Two Disorders

While the differences in symptoms are subtle, there are ways to differentiate between the two disorders. For example:

Symptoms For a Person with Schizoaffective Disorder

• Symptoms meet the criteria for schizophrenia, but they also experience a major mood episode at the same time throughout the active and residual phases of the schizophrenia symptoms. This can be divided into two subtypes: a depressive type or a bipolar type.
• They must also experience a consecutive period of at least two weeks with the presence of delusions or hallucinations without any evidence of a mood episode at some point in the course of their illness in their lifetime. That means they continue to have psychotic symptoms in the absence of a mood episode, which helps to differentiate it from a mood disorder with psychotic features.
• The prognosis for schizoaffective disorder is somewhat better than for schizophrenia.

Two Subtypes of Schizoaffective Disorder

There are two subtypes of schizoaffective disorder:

• Bipolar type: Characterized by episodes of mania including euphoric mood, increase in energy, less need for sleep, impulsive and reckless behaviors such as shopping, gambling, and sexual escapades. Depressive episodes are possible but not necessary.
• Depressive type: Characterized by episodes of major depression without mania. In this subtype, symptoms must include a pervasive sad mood over and above the loss of interest or lack of pleasure common to the negative symptoms of schizophrenia.

Symptoms For a Person with Schizophrenia

• A person with schizophrenia can also have mood episodes of depression or mania, but they do not last the entire life course of their illness. In this case, they may be diagnosed with schizophrenia with major depressive disorder or bipolar disorder as a comorbidity. For example, someone may experience a depressive episode at the same time they are experiencing symptoms of schizophrenia. If the mood symptoms subside and the schizophrenia persists for several more years, the appropriate diagnosis is schizophrenia. Conversely, a person with schizoaffective disorder will experience chronic and persistent mood symptoms.
• Psychotic symptoms in schizophrenia tend to be persistent, while a person with schizoaffective disorder will generally have briefer episodes of psychotic symptoms that come and go.

Compare and Contrast

Schizoaffective

• Hallucinations

• Delusions

• Flat affect

• Disorganized thinking

• Psychotic symptoms are brief and episodic

• Mood symptoms (depression or mania) are concurrent with and persist throughout the course of the psychotic episode

It is important to note that these two conditions are not the same as schizoid personality disorder or schizotypal disorder, which are personality disorders that also impact thinking and the ability to relate to others. People who have these personality disorders do not have the same degree of psychosis and lack of insight that is characteristic of schizophrenia and schizoaffective disorder.

Recap

In schizophrenia, the psychotic symptoms are almost always present, but the mood symptoms come and go or disappear altogether.

In schizoaffective disorder, the psychotic symptoms and mood symptoms come and go together, with the mood symptoms being present the majority of the time alongside the psychotic symptoms. There must also be a period of time where psychotic symptoms are present without any mood symptoms to confirm it is not a mood disorder with psychotic features.

Causes

Researchers do not know exactly what causes schizophrenia or schizoaffective disorder. They believe that there are a number of different factors involved.

Genetics are believed to play a role in increasing a person’s risk for developing either condition. Other factors that appear to play a part in causing schizophrenia are similar to schizoaffective disorder, including differences in brain chemistry and abnormalities in the brain. 

For both conditions, environmental factors, including trauma, stress, or substance use, may trigger the onset of symptoms in people who have a genetic predisposition to the condition.

Treatment

It is important to distinguish between these two conditions because treatments for each differ. For example, treatment for mood disorder symptoms is necessary for schizoaffective disorder but might not be necessary for schizophrenia.

Most people who are diagnosed with schizophrenia have a chronic and persistent course of illness. The treatment of schizophrenia relies mostly on a special group of prescription medications called antipsychotics.

These include older antipsychotic medications like Haldol (haloperidol) and Thorazine (chlorpromazine). There are also newer medications including Risperdal (risperidone), Zyprexa (olanzapine), Geodon (ziprasidone), Seroquel (quetiapine), Saphris (asenapine), and Latuda (lurasidone).

Maintenance treatment for schizophrenia almost always includes an antipsychotic medication.

The treatment for the psychotic symptoms of schizoaffective disorder also includes antipsychotics. Paliperidone (Invega), an atypical second-generation antipsychotic, is the only FDA-approved medication indicated to treat schizoaffective disorder, although all the other antipsychotic medications are commonly used.

For mood symptoms, people who have schizoaffective disorder are prescribed antidepressants if they have the depressive type and mood stabilizers, such as valproate or lithium, if they have the bipolar type.

Recap

Both schizophrenia and schizoaffective disorder are typically treated with antipsychotic medications. Schizoaffective disorder is also treated with antidepressants or mood stabilizers. People who have schizophrenia usually do not need to take mood stabilizers or antidepressants, but sometimes these medications are needed in addition to antipsychotics.

Prevention

There is no way to prevent either schizophrenia or schizoaffective disorder. However, it is possible to improve treatment outcomes and prognosis by getting help as early as possible.

If a person notices symptoms of psychosis or mood problems, it is important to talk to a healthcare provider to receive an appropriate diagnosis. Prompt treatment can help reduce symptom severity and frequency. It can also minimize the detrimental effects that symptoms may have on a person’s life and relationships.

Psychotherapy and skills training can also be beneficial when used alongside medication. It may help people better understand their symptoms, establish goals, and cope with the daily challenges related to the condition.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Adrian Preda, MD

Adrian Preda, MD, is a board-certified psychiatrist with specialties in adult and geriatric psychiatry and clinical neuropsychiatric research.

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