IndexDiagnosis of Schizoaffective DisorderC.WZ Case Study of Schizoaffective DisorderPossible Treatment ModalitiesDiagnosis of Schizoaffective DisorderAccording to the Diagnostic and Statistical Manual of Mental Health (5th ed.; DSM-5; American Psychiatric Association [APA], 2013), to be diagnosed with schizophrenia you must experience at least one of the three symptoms listed below: 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 take it a step further, they must experience these symptoms for a minimum of six months (APA, 2013). Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay According to UpToDate (Fischer & Marder, 2018), schizophrenia affects only about 1% of the world's population. This is especially difficult to measure because different cultures recognize and classify mental health disorders differently. This disorder affects men slightly more than women and onset typically occurs during adolescence (Fischer & Marder, 2018). The diagnosis of bipolar I disorder requires the individual to meet certain criteria and the following criteria are what constitutes a manic episode. According to the DSM-5, Criterion A states that a manic episode must involve a discernible period of at least one week in which one experiences an abnormally elevated or irritable mood (APA, 2013). This will include a jump in energy and/or activity and will occur almost every day (APA, 2013). Criterion B states that the change in mood must involve three or more of the following significant behavioral changes: increased self-esteem or grandiosity, decreased need for sleep, more talkativeness than normal, volatile ideas or racing thoughts, distractibility, increased attention to 'goal focused activities, abnormal amount of time and thoughts devoted to activities with potentially negative consequences such as gambling and risky sexual encounters (APA, 2013). Criterion C includes the presence of psychotic features or a change in mood severe enough to impair the individual's ability to function socially and professionally or to require hospitalization to avoid harm to self or others (APA, 2013) . Criterion D adds that none of the above phenomena can be caused by another condition or by substances such as drugs or treatments (APA, 2013). According to the UpToDate article titled "Bipolar Disorder in Adults: Epidemiology and Pathogenesis," bipolar disorder affects between 1% and 3% of the world's population. This disorder affects men and women equally, and the average age of onset of bipolar I disorder is 18 years, while the average age of onset of bipolar II disorder is 20 years (Stovall, 2018). Schizoaffective disorder affects only 0.3% of the world's population and is therefore about a third more common than schizophrenia (“National Alliance on Mental Health,” 2018). This disorder bridges the gap between schizophrenia and bipolar disorder. According to the DSM-5, at least two of the criteria symptoms of a schizophrenic must be manifested and then one must also have a major mood episode (mania or depression that lasts for an uninterrupted period of time), delusions or hallucinations for more than two weeks without mood symptoms and mood symptoms present for most of the illness (which cannot be caused by substance abuse) (APA, 2013). Schizoaffective disorder is essentially a mix of schizophrenia and bipolar, so it can be quite difficult to diagnose. To individualsthe presence of one or the other could initially be diagnosed based on the most widespread symptoms. Due to the delusions and/or hallucinations they may experience, they may seem extremely paranoid and…anxious. Peers may consider many of their thoughts, beliefs, and actions to be totally out of character and completely disorganized. They may engage and become completely absorbed in religion. Outside of the extremes, it is common for these individuals to appear apathetic and confused. The bipolar characteristics of this disorder put the person in a manic or depressed state. In a manic state they appear quite euphoric and may think of themselves as superior to others. They may think they are super rich, high status, or extraordinarily intelligent. They may talk fast, racing thoughts, insomnia and anger. In a depressed state they may feel tired and sad almost constantly. They may have suicidal thoughts, difficulty concentrating, loss of appetite, and a desire to carry out full daily activities. Most often, a person with schizoaffective disorder primarily exhibits symptoms of psychosis before symptoms of a mood disorder begin to appear. This is different from someone with bipolar who will only exhibit symptoms of psychosis when experiencing a mood swing. Because most individuals will be diagnosed with schizophrenia or bipolar disorder before being diagnosed with schizoaffective disorder, not much is known about the living patterns of the illness. Observing the onset of both schizophrenia and bipolar disorder is sometimes all that can be done because either one or the other symptoms will shine through initially. Not much is actually known about the cause of schizoaffective disorder. Some studies seem to suggest that there is most likely a genetic component. In this case, the combination of a variety of genes over time could lead to mental illness. It is believed that “among these genes there are some that regulate the daily rhythms of the organism, such as the sleep-wake cycle; others that help control the movement of nerve cells during brain development; and still others involved in sending and receiving chemical signals in the brain (“Schizoaffective Disorder – Genetics Home Reference”, 2018).” Genes involved in the production of GABA neurotransmitter receptors may also be associated. An individual has a greater chance of contracting the disorder if a first-degree relative has it ("Schizoaffective disorder - Genetics Home Reference", 2018). Mental health diagnoses are different across different cultures. In the past, even the DSM has struggled with the diagnostic criteria for schizoaffective disorder. The first two versions of the DSM included schizoaffective psychosis as a subtype of schizophrenia that included both psychotic and affective features (Wilson, Nian & Heckers, 2013). Since the diagnosis of “schizoaffective disorder” is still being defined among professionals, it is more pertinent 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 an Indian Perspective,” schizophrenia is less prevalent in developing countries; however, this is most likely due to underestimation (Viswanath & Chaturvedi, 2012). It may not always be that some diseases are defined differently by healthcare professionals around the world, but many may not come forward. This could be because they are not concerned, because they fear being marginalized, or perhaps because they don't know that anything can be done about it. Interestingly, in some religious ceremonies it is normal to hear voices that others cannot hear. This showssimply that in some cultures it might be perfectly acceptable to hear voices; however, these people may not know that when these rumors continue, it may 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 past medical history he had been diagnosed with schizophrenia; However, after being admitted to 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 have had a chance to further explore his symptoms and they have since changed that diagnosis. to schizoaffective disorder, bipolar type. CWZ came to Denver Health complaining of right leg pain and was treated for cellulitis. He then returned the next day for persistent pain and after further assessment was admitted to the mental health unit for extreme psychosis. He had not followed discharge instructions from Porter Hospital when he was admitted to Aurora North and it quickly became apparent that he had not adhered to his new outpatient plan either. CWZ not only needed assistance with medication adherence, but needed help with self-care and basic safety. Along the lines of a diagnosis of schizophrenia, this individual's thoughts were disorganized, he had problems with cognition, memory judgment, and impulse control. He also had severe clinical manifestations such as hallucinations, delusions, mania, acute psychosis, extreme agitation, and anxiety. Among other things, the presence of mania and agitation are what differentiates his diagnosis from schizophrenia. He clearly demonstrated racing thoughts through his racing speech, exhibited behaviors of grandiosity, slept very little, and was very easily distracted. These symptoms of schizophrenia and bipolar mania are what led this patient to the diagnosis of schizoaffective disorder. After spending approximately two hours with the patient in the mental health unit at Denver Health, some specific examples emerged that quite accurately reinforce this diagnosis. CWZ was living with his mother at the time of his hospitalization, however, in some of his stories he claimed to have been homeless in the recent past. CMZ reports that he has a degree in technological design and that every time he tries to find work in this field the employer is threatened by his talent and finds a way to ruin his work. He said that if he could get a job, it would be building lasers and robots. Then it would use these lasers to make furniture just like in Ikea. It was no surprise that he moved from job to job because he told many stories of paranoia that his colleagues were trying to poison him. In most cases, they poisoned the rim of his soda, which he considered completely normal. He stated that when he gets out of Denver Health he will go get his laser from his friend so he can sell it for a new car. He said this friend stole his old car and drove 20 miles every night. He also liked to talk about how he did technology design for big rock bands. CMZ quickly moved from one story to another and it was very difficult to decipher where one story ended and another began. These are just a few examples of his delusions, his disorganized and frenetic speech, and his thoughts of grandeur. Before arriving at Denver Health, CMZ had previously been prescribed lorazepam for anxiety, zaleplon for insomnia, cariprazine for schizophrenia and bipolar mania, clonazepam for anxiety, lamotrigine for bipolar disorder, primidone forseizures, seroquel for schizophrenia, bipolar disorder and major depressive disorder and ambien for insomnia among other medications such as laxatives. These eight drugs were prescribed for schizoaffective disorder. Some were for psychosis, some for mania, and some for anxiety and insomnia. While these medications may have been effective enough to warrant a discharge order from Aurora North, CMZ was not fully compliant in his short time out of the hospital and so doctors at Denver Health decided to go in another direction. All of CMZ's previous medications were stopped and he was started on atarax for a variety of things such as anxiety, insomnia and irritability, zyprexa for schizophrenia and bipolar mania, and lithium for bipolar disorder, plus other medications such as antibiotics . No mental health related medications were continued. This was a clean slate for both doctors and patient. This was a significant reduction in the number of medications, and although some of them are very similar, it was a brave choice to start from scratch. Three days after starting treatment with this new drug regimen, CMZ was starting to show signs of improvement, although much more time was needed in his treatment for the full effects to be seen. Possible treatment modalities The dominant method for treating disorders such as Schizoaffective disorder is associated with a multitude of different 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 rigorous regimen. If mental health disorders could be treated with one medication instead of ten, the patient is much more likely to continue with post-discharge care. Patients with schizoaffective disorder are commonly prescribed symptom-specific medications; as in the case of CMZ, who were individually prescribed mood stabilizers, anxiolytics, antipsychotics, sedatives, and so on. 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 as monotherapy or in combination with mood stabilizers and/or antidepressants, helped establish the drug as a safe, effective, and acute treatment of [schizoaffective disorder]” (p. 381). This study included 614 schizoaffective (depressive or manic) patients divided into two groups. One group received 6 mg per day (the amount could be changed after 3 days) of ER stakes and one group received a placebo. All other medications were appropriately discontinued. Using PANSS, HAM-D-21 AND YMRS scores, patients were analyzed after 4 days and then after 1, 2, 3, 4 and 6 weeks. Patients with schizoaffective disorder who experienced depression or mania tended to see significant improvement with Pali ER within the first week of treatment (Fu et al., 2015). If patients like CMZ, who struggle with noncompliance, could be treated with a single medication for schizoaffective disorder and perhaps another mood stabilizer or antidepressant, it would be extremely helpful in maintaining a healthy and balanced lifestyle because they would have many more likelihood of continuing with their care. In-depth studies on the effects of paliperidone could influence healthcare providers to more reliably turn to simpler drug therapies for their patients. Unfortunately, even though drug therapies may be increasingly simplified, if patients don't have insurance, it won't matter..