"What is schizoaffective disorder? Is it worse than bipolar disorder?" That's what I'm discussing today. I'm Dr. Tracey Marks, a psychiatrist, and I make mental health education videos. This video is based on several viewer questions. Saxon Survival says, "I was just diagnosed with schizoaffective bipolar disorder type. Can you make a video explaining more about this? Is it worse or better than having just schizophrenia or bipolar?" Bipolar Corner says, "Dr. Tracey Marks, could you please do a video diving deeper into what schizoaffective disorder is like, the signs and symptoms, and discuss some of the ways of treating it, please? Thank you." Thank you, Saxon Survival and Bipolar Corner. I know that Bipolar Corner started his YouTube channel talking about his struggles with bipolar disorder and then his diagnosis changed to schizoaffective disorder. These kinds of changes can happen when your illness progresses and your symptoms evolve more. Schizoaffective disorder is a combination of schizophrenia and a mood disorder, either bipolar disorder or depression. Where does the term 'affective' come from? In psychology, there's a concept called the ABCs of psychology. It divides the mind into three domains. A is for affect, which is your emotions or feelings, B is for behavior, and C is for cognition, which is how you think. Mood disorders like depression and bipolar disorder primarily affect your emotional expression, so they're called affective disorders. Whereas schizophrenia at its core affects your thinking, so it's more of a cognitive disorder. With schizoaffective disorder, you get a combination of the alterations in your emotions and your thinking abilities. There's still a debate within the psychiatric community as to whether or not schizoaffective disorder should be a separate disorder from schizophrenia because symptom-wise, schizoaffective disorder really looks more like schizophrenia than it does bipolar disorder or depression. That is, people with schizoaffective disorder are more on the schizophrenia spectrum than the mood spectrum. I did a video where I explained what schizophrenia is. You can see the link in the description and in the corner of this video. But the gist of it is that schizophrenia is a disorder where a person has psychotic symptoms as well as cognitive symptoms. The psychotic symptoms are hallucinations, delusions, or severe thought or behavioral disorganization. A person with schizophrenia isn't necessarily depressed. They may get agitated, but that agitation is not the same as mania. Mania is an elevated or irritable mood along with other things like increased energy, a decreased need for sleep. The person with pure schizophrenia isn't experiencing these things. So what happens with schizoaffective disorder is you have a depressive illness or bipolar illness superimposed on the schizophrenia. The diagnosis that you'll get is called schizoaffective bipolar type or depressive type. Here's how the illness looks different from bipolar disorder or depression. And for the sake of this example, let's just look at the bipolar type of schizoaffective disorder. With bipolar disorder, you have separate episodes of mania and depression. In between those episodes, you either have no symptoms or very few symptoms of whichever episode you last had. Now you can become psychotically depressed or you can have mania with psychotic symptoms. In this case though, the psychosis is a measure of the intensity of the illness and the psychosis resolves as the episode improves. So here's how it would look for just pure mania that's part of bipolar disorder. Let's say you become manic and you start believing that you're a part of a sting operation spearheaded by the CIA. And the CIA has recruited you to do your own investigation. So as part of that manic episode, you start staying up all night researching on the internet. But when you start taking medication, you settle down and you no longer believe you're part of the sting operation. But you still have some manic symptoms like you may not be sleeping or you may have pressured speech and you just can't stop talking. But you're thinking rationally. As your manic episode continues to resolve, everything slows back down. Now let's take this same scenario with schizoaffective disorder. In this case, before your mania starts, you already are believing that the CIA is gathering intelligence on people. And because of that, you refuse to answer the phone because you feel like signals are coming through the phone. Notice with this delusion, it's a little more bizarre and unbelievable than with the manic delusion. Then you start losing sleep and you start believing that you're being recruited to help with the surveillance. So you go through your mania but after your mania resolves, you still believe that the CIA is doing something evil or you no longer believe the CIA thing but you've moved on to a different kind of conspiracy. And you continue to have this delusion for a little while until it tapers off and you stop thinking about it. But as it's tapering off, you're neither depressed nor manic. Now this can get complicated because you can have schizophrenia and major depression as a second illness without it being schizoaffective disorder. And the difference here is that with schizophrenia plus major depression, you spend more time with psychotic symptoms relative to the amount of time you spend in a depression. So you're mostly psychotic with these pops of depression. With schizoaffective disorder, depressed type, for most of the illness you're both psychotic and depressed. And you'll have psychotic symptoms before or after your mood symptoms resolve. When it comes down to it though, there's only minor differences in the kind of treatment that you're going to get. A person with bipolar disorder is going to be on mood stabilizers. If you have bipolar disorder, your medication regimen may change depending on the state of your illness. What it took to get you better may not be the same medication that keeps you better. Let me put it a different way. Sometimes the medicine that your doctor uses to treat an acute episode will be different from the medications used when you're in the maintenance phase. The maintenance phase is the period where you're either without any symptoms or have very few symptoms. And the goal is to prevent another episode or at least control the onset of another episode. The main medications that we use to treat bipolar disorder are mood stabilizers. And these are anticonvulsant mood stabilizers like valproic acid or lamotrigine. And then there's the antipsychotic medications also called neuroleptics. They're also used for mood stabilization. A person with bipolar disorder will be on a mood stabilizer that may or may not include a neuroleptic. But the person with schizophrenia will be only on a neuroleptic. If you have bipolar 2 disorder, you may also be on an antidepressant at some point during your illness. I have another video talking about when you do and do not want to take antidepressants for bipolar disorder. A person with depression will be on an antidepressant. And if you become psychotically depressed, you may take a neuroleptic for a temporary period of time. Or if you have treatment-resistant depression, you may have a neuroleptic added to your antidepressant. So there is some overlap between these illnesses and the medications that you can take. So you can't always look at someone's medication list and work backwards to know what their diagnosis is. Probably the best way to think about comparing the treatment between bipolar disorder and schizoaffective disorder bipolar type, is with bipolar disorder you may or may not take a neuroleptic. But with schizoaffective disorder, you will always need to be on a neuroleptic. So getting back to the question of whether or not schizoaffective disorder is worse than bipolar disorder. In some ways, yes. Because you've got bipolar disorder with the additional burden of a chronic psychosis. If you have bipolar 2 disorder, you may never become psychotic. But the bigger issue is that since schizoaffective disorder is thought to behave more like schizophrenia, you get the cognitive decline that you don't get with bipolar disorder. Yes, when you are depressed or manic, you can have thinking problems. But a schizophrenia spectrum illness affects your thought processing, problem-solving abilities, judgment, and insight in a much bigger way than it does with bipolar disorder or unipolar depression. Check out this video on when not to take antidepressants.