NUR 637: Schizoaffective Disorder Case Study - Diagnosis and Treatment

This report presents a detailed case study focusing on schizoaffective disorder, a severe mental illness characterized by a combination of schizophrenia symptoms and mood disorder features. The case study begins with an overview of schizophrenia and its subtypes, including schizoaffective disorder. It then explores the symptoms, diagnostic methods, and various treatment approaches, including pharmacological interventions such as antipsychotics, mood stabilizers, and antidepressants. The case study also highlights non-pharmacological treatments like psychosocial therapy and coordinated care. The patient's history, symptoms, and response to treatment are analyzed, providing insights into the management of schizoaffective disorder. The study emphasizes the importance of early diagnosis, comprehensive treatment plans, and the integration of both pharmacological and psychosocial interventions to improve patient outcomes. The report includes information on the different types of drugs, their mechanisms of action, and their role in managing the symptoms of schizoaffective disorder. It also discusses the importance of family and peer support, rehabilitation therapy, and cognitive behavioral therapy in improving the patient's quality of life. The case study also highlights the importance of using imaging techniques and mental assessment tests to identify the changes in the structure of the brain.

Running head: SCHIZOAFFECTIVE DISORDER
1
Schizoaffective Disorder
Name of the Student
Name of the University
Authors Note

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Schizoaffective Disorder
Schizophrenia is one of the severe mental disorders where the patients connect with the
reality in an abnormal way (Frith 2014). There are many types of schizophrenia that are mainly
classified; these are paranoid, hebephrenic, catatonic, childhood disorders and schizoaffective
disorder. The patient with schizoaffective disorder mostly experiences both the symptoms of
schizophrenia like hallucinations, delusions and a chief mood-related disorder like depression,
anxiety at the same point of time (Arion et al., 2015). Catatonia is a severe condition where the
patient experiences a series of additional complications, mainly bipolar disorder (Walther &
Strik, 2016). It is regarded as a specifier for the state of schizophrenia. The condition and signs
of schizophrenia may arise during childhood as well, which needs special attention and a fast
cure. Hebephrenic is a condition that is also a part of a kind of schizophrenia where the patient
has muddled thinking and actions (Park & Kang, 2015). The speech and as well as the thought is
equally hampered by it. Paranoid is mainly a delusion condition, which is also experienced by
the patients (Pinkham, Harvey & Penn, 2016). There are many symptoms of this disease,
primarily categorised by positive and negative once. The positive symptoms of schizophrenia are
somatic delusions, rare or restricted body movement, and auditory hallucination (Ardizzi et al.,
2016). The negative symptoms are limited or no social interactions, lack of insights or feeling of
loneliness (Marder & Galderisi, 2017). There are few more symptoms also be considered as an
indication of this disease like isolative behaviour, repetition or reappearance of words, running
commentary, suicidal affinity and frenzied speaking.
There are many ways by which schizophrenia can occur, these are –
Genetics- The disease can be caused due to defective inherited gene from the family (Neale &
Sklar, 2015).

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Neurological Cause- The disease can also be caused due to the defective secretion of
neurotransmitters, especially dopamine.
Defective development of the Brain- The structure of the brain cortex or the ventricles may be
enlarged, resulting in a schizophrenic condition (Stegmayer et al., 2016). Environmental
influences may also lead to the development of this condition. The primary purpose of the below
paper is to provide a proper idea about the disease a mental illness called schizoaffective disorder
along with its diagnoses stage, medications, treatment based on a case study.
Schizoaffective Disorder is a condition where mainly two types of signs observed, one is
the bipolar type, and the other is depressive type. Here rare major depression along with mania is
often observed. Whereas, in the depressive condition, a long period of depression is found
among the patients (Coryell, 2016). The signs and symptoms of this disease are false or static
beliefs in-spite of having evidence of the issue, hearing voices or observing imaginary things,
impaired statement and language, unusual behaviour, feeling of emptiness, prolonged insomnia,
lack of social role or involvement, suicidal feelings as well as the impaired movement of the
body.
There are many ways by which this disease can be diagnosed. The standard tests are
Magnetic Resonance Imaging and X-rays (Schnack et al., 2014). The patient’s history, activity,
behaviour, signs and symptoms of the disease can be estimated by the mental assessment test
(Coaley 2014). It is a process of detecting and recounting a patient’s performance and balanced
functions at a particular time in a fundamental mode. The imaging techniques are used to
identify the changes in the structure of the brain (Bakhshi & Chance, 2015). The patients with
this kind of schizophrenia or schizoaffective disorder show a lower quantity of entire brain
volume as well as enlarged ventricular portions in the brain structure. The imaging technique

SCHIZOAFFECTIVE DISORDER 4
also reveals about the variations in the zones of the hippocampal and thalamic proportions and a
sudden increase in the quantity of Globus pallidus, the changes in the grey matter of the brain is
also observed among the patients with schizoaffective disorder (Amann et al., 2016). All these
are kinds of physiological changes observed among the patient who has this disease. The tests
are useful as it provides complete structural and functional evidence about the patients’ health.
There are two critical central states among the patients with the schizoaffective disorder; these
are mood and affect. Mood is a kind of fundamental emotional sensation resulting from a fixed
stimulus, whereas affect is the manifestation of the feeling, which refers to the state of mind
(Chui et al., 2016). The mood is generally challenging to determine but affect is always visible.
Mood is usually recognized by anger, depression, irritations.
The case study is based on an adult. The patient was varieties of symptoms of blocking
thoughts, auditory hallucinations, lack of friends and social involvements, ability to know future,
perceptual troubles; she could also hear voices advising directions, along with that the patient
also faces suicidal thoughts when in pressure or stressed, some other symptoms of the patient
was a mixed episode of feelings like manic, insomnia, hyper-impulsive (Arion et al., 2015. The
patient also reduced her interaction with society, and due to this left her job. The patient was also
experiencing manic symptoms like mood swings, impulsivity, and grandiosity. After her
admission in the hospital and after observing her, it was found that she was having poor sitting
posture, high-pitched voice, a bit of thought blocking process was also there. The suicidal
symptoms was also reduced, but she still hears the voices like before.
The patient was having the symptoms of schizoaffective disorder, which combine both
mood disorder, along with the signs of schizophrenia (Wilson, Nian & Heckers, 2014). The
symbols such as auditory hallucination, mood affect, mania, sleep disorders, defective body

SCHIZOAFFECTIVE DISORDER 5
movement are a clear indication of schizoaffective disorders. The symptoms of this disease were
developed in her from the age of 18. The developmental phase can be early adulthood which can
happen due to any external factor or hereditary reasons.
The most common diagnoses of the condition can be physical examinations, which will
brief about the patient history, medication, along with identification of current state and
symptoms. Psychiatric assessment is the most critical diagnosis for any age patients; it is a
process of examination of any patient’s behavior, personality, mental abilities (Ben-Zeev et al.,
2015). The main motive behind the observation is to assess the patient's life related to the
psychological aspect, which is the leading cause of the symptom. The test primarily follows the
Diagnostic and Statistical Manual for Mental Disorders also known as DSM-5, according to the
principles the patient must be having a continuous period of uneasiness with significant mood
episode (Mattila et al., 2015). The symptoms that are evaluated for are hallucination, delusion,
blocking of thoughts and disrupted speech. Here, the patient is experiencing an auditory
hallucination, delusions, random thoughts as well as defective speech; this test will be helpful in
detecting the level of the mood.
The treatments that can be given to the patient are antipsychotics, mood stabilisers and
antidepressants. There are several types of antipsychotic drugs that help in reducing the
symptom. It primarily works in the chemical signals of the brain such as neurotransmitters like
dopamine and serotonin. The groups of this drug are first-generation, or typical drug and the
other group is second-generation or atypical drugs. The most common drugs that can be used as
a treatment option for the patient are- chlorpromazine, haloperidol, thioridazine, trifluoperazine,
thiothixene, fluphenazine (Tardy et al., 2014). These drugs are mainly neuroleptic, dopamine
antagonists. The drug reduces the positive as well as negative symptoms of the disease by

SCHIZOAFFECTIVE DISORDER 6
inhibiting the four dopamine pathway. The mesocortical route, it is a path by which the ventral
tegmentum, is connected with the prefrontal cortex, extensive activity of this pathway leads to
the negative symptoms of schizophrenia. It is the central portion associated with abnormal
functions, especially in the case of schizophrenia. Excessive or high doses of this first-generation
drug block this pathway and can decrease the symptoms. The next target pathway of these drugs
are mesolimbic pathway; overexpression of this pathway leads to the increase of positive signs
the disease among the patients. The antipsychotic medication mainly blocks the D2 receptor of
this mesolimbic pathway (Divac et al., 2014).
The next pathway that is targeted by these drugs is the nigrostriatal pathway, which is
related to extrapyramidal symptoms. Here in this pathway, the drug targets the D2 receptors in
order to diminish the symptoms of schizophrenia. The last pathway that is targeted by the drugs
are tuberoinfundibular pathway, and here the drug enhances the level of prolactin as the
dopamines reduce the production level of prolactin by inhibiting it. Phenothiazines are the largest
group of first-generation antipsychotic medication. However, there are many non-phenothiazines
drugs also used to treat diseases like dibenzepines, thioxanthenes, butyrophenones and
diphenylbutylpiperidines. Among the medicines, chlorpromazine is the highest anticholinergic
effect with high hypotensive effect (Kowalski et al., 2017). The list of potency can be top for
haloperidol and fluphenazine, chlorpromazine as low strength and perphenazine and loxapine as
medium strength.
The second generation of antipsychotic drugs acts by reducing the extrapyramidal effects
by blocking, and it also increases the clinical effectiveness of the dose of medicine (Divac et al.,
2014). The medications that belong to this class are aripiprazole, aripiprazole lauroxil,
cariprazine, clozapine, iloperidone, lurasidone, quetiapine and ziprasidone.

SCHIZOAFFECTIVE DISORDER 7
The doctors also prescribe antidepressant drugs to reduce schizoaffective disorders
among the population (Correll et al., 2015). These drugs mainly reduce the negative indications
of this disease. These drugs are generally given along with antipsychotics, especially with the
second generation of antipsychotics. Few recommended drugs are citalopram, escitalopram,
fluvoxamine, paxils, sertraline and viibryd. All these are selective serotonin reuptake inhibitors
(SSRIs). Another variety of antidepressant is serotonin and norepinephrine reuptake inhibitors
(SNRIs); these works by hindering the reabsorption of both the neurotransmitters. Most common
representatives of these class of drug are Cymbalta, Effexor, pristiq and fetzima. Tricyclic
antidepressant or tetracyclic antidepressants work by blocking the absorption system of serotonin
and dopamine. Examples of these drugs that are used in the curing of this condition are asendin,
amitriptyline, sinequan, tofranil and many more. The earliest antidepressant medication that is
given are monoamine oxidase inhibitors or MAOIs; these drug works by blocking the enzyme
monoamine oxidase which disruptions the neurotransmitters of the brain. Examples of these are
selegiline, nardil, parnate and marplan.
All these drug therapies are effective in planning the treatment of the schizoaffective disorder.
There are many non-pharmacological approaches for the treatment of schizoaffective
disorders among them two most important are psychosocial treatment and coordinated care.
There are many forms of psychosocial therapy which helps the patients to adjust and to cope up
with the atmosphere of the society as well as it reduces the feeling of loneliness along with it also
reduces the suicidal thoughts as the patient is fully engrossed with variety of works (Jones et al.,
2018). These will build a mental as well as social support. The patient with mental illness is
always in need of peer support which helps in reducing the disease. Coordinated therapy is also
helpful for this kind of patient as the treatment involves more both medicine and social therapies

SCHIZOAFFECTIVE DISORDER 8
to improve the patient's state of mind. Here, the family and peers also play an active role in
encouraging the patients suffering from schizoaffective disorder to lead a healthy life. Another
type of social therapies that can be provided to the patients is rehabilitation therapy, which is a
training system that is offered to the patients to live life independently and to involve in various
functions of the society. Cognitive medication can also be provided to this kind of patient as it
enhances the skill of mental abilities and exercises. This process is effective in strengthening the
memory as well as improving the problem-solving skills. Family involvement and caring help in
improving the spiritual condition of the patients. Cognitive Behavioral therapy is one of the most
robust treatment options for the kind of patients (Laws et al., 2018). The primary aim of this
therapy is to alter the way of thinking among the patients with difficulty in thoughts. It is mainly
given to patients with depressions and anxiety. The steps of performing the treatment are
identifying the trouble or the condition of the patient, suitable conscious of the sentiments, the
empathy of negative and unsuitable thinking’s or thoughts and finally addressing and resolving
the problem.
The conditions that were faced by the women, in this case, are disruption of thoughts,
auditory hallucinations, and perceptual disturbance. Antipsychotic drugs can reduce these
problems; examples are clozapine, clonidine, aripiprazole. The mood stabiliser drugs can also be
given to patients are lamotrigine and carbamazepine. These drugs normalizes the synaptic
plasticity and neurotransmitters in the brain (Kessing et al., 2018). However, the patient was
already under medication for one year, which decreased the auditory hallucination.
The recent problems that were faced by the patient are poor body posture while sitting,
high tone of voice, hostility, distraction in works and reduced decision-making ability. The
patients with schizophrenia often experience this non-verbal abnormality (Tyburski et al., 2015).

SCHIZOAFFECTIVE DISORDER 9
A meta-analysis also performed to address the issue which has highlighted that this change of
tone is a symptom of negative schizophrenia. Amisulpride is an effective antipsychotic drug that
can be given to reduce this problem (Kahn et al., 2018). The problem of short concentration time
can be resolved by meditation in the patient. It has in relaxation of the mind as well as the body,
which will also reduce the hypertension problem. Social involvement is also recommended for
the patient which will also reduce the problem of poor decision-making abilities. However, the
current condition of the patient can also be judged by an imaging examination like Magnetic
Resonance Imaging or CT scan. It will effectively show the structural differences in the areas of
the brain. The patient has already got rid of her suicidal thought which is another essential
positive sign of improvement in the condition. The development of her health may be due to
poor communication of neurotransmitters which is dopamine and serotonin. The other cause can
be a genetic factor that is inherited from the ancestors. However, paliperidone is the only
medicine granted for the schizoaffective patients by the Food and Drug Administration, which
will effectively reduce the condition of hallucination more (Schreiner et al., 2015). The doctors
can also recommend and communication with the survivor for getting involved in the work
which will increase and improve the decision-making ability and will also increase the
concentration level of the patient.
The plan for caring schizoaffective patients can by health care practitioners are- proper
identification and recognition of the condition that the patient is experiencing, here the patient is
going through schizoaffective disorder. The plan of treatment must be comfortable for the
patients, which will help in developing a trust relationship with the patient, here the patient needs
peer support that can bring effective intervention in the curing. The caregiver must focus upon
providing maximum involvement in any activity either by physically or mentally, which will

SCHIZOAFFECTIVE DISORDER 10
reduce the patient's lack of invitation. The caregiver can also plan for stress management
strategies for which will also reduce the intake of antipsychotic drugs. These drugs have many
side effects as well like- restlessness, insomnia, risk of diabetes, neurological disorders, loss of
weight and many more (Owens, 2014).
The above paper discussed about the disease schizoaffective disorder, its signs and
symptoms. The condition is many caused due to disorientation or defective neurotransmitters-
dopamine and serotonin. It also focuses on the different antipsychotic drugs, mood stabilizers
along with its mechanism of action to reduce this disease. It also concentrates upon the few anti-
depressive drugs, as depression is common with schizophrenia. Other medications can be mood
stabilizers. However, the paper also gives an idea of non-pharmacological intervention in
reducing this disease. Lastly, the paper discusses about new treatment plans that can be useful in
curing schizoaffective disorders.

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