What is the main difference between schizophrenia and schizoaffective disorder?

Although they share some similarities, schizoaffective disorder and schizophrenia are two distinctly different disorders.

Each has its own diagnostic criteria, as well as different treatment options. Both involve psychotic symptoms like hallucinations, delusions, and cognitive impairments, but schizoaffective disorder also has features of a mood disorder.

Read on to learn more about these two mental health conditions.

Schizoaffective disorder is a chronic mental health condition. According to the National Alliance on Mental Illness, the hallmarks of schizoaffective disorder include psychotic symptoms of schizophrenia-like hallucinations or delusions, with symptoms of a mood disorder like mania or depression. It’s a rare condition, with a lifetime prevalence of just 0.3 percent.

What are the symptoms?

Symptoms of schizoaffective disorder need to be monitored, as they can be severe in some people. Symptoms can also vary depending on the mood disorder diagnosed (depression or bipolar disorder). They can include:

• hallucinations
• delusions
• disorganized thinking
• depressed mood
• manic behavior

Other symptoms can include:

• trouble concentrating
• changes in appetite
• poor personal hygiene
• trouble sleeping
• social isolation

How is it diagnosed?

Sometimes, it can be tricky to diagnose schizoaffective disorder, since it has symptoms of both schizophrenia and a mood disorder. There are two types of schizoaffective disorder:

• Depressive type. With this type, you only have major depressive episodes.
• Bipolar type. This type includes manic episodes, with or without depressive episodes.

Your doctor will do a physical exam to rule out any other causes for your symptoms. They will ask about any drugs or medications you may be taking. If you go to your primary care doctor, they may refer you to a mental health professional.

A psychiatrist or other mental health professional will talk with you to learn about your symptoms and what you are experiencing. They will ask about your family history and any other psychiatric history you might have. To make a diagnosis, they will use criteria from the “Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).”

To get a schizoaffective disorder diagnosis, you must have these symptoms:

• period when there is a major mood disorder at the same time when schizophrenia symptoms are present
• delusions or hallucinations for 2 or more weeks without a major mood episode
• symptoms meeting criteria for a major mood disorder occur for a majority of the time
• symptoms cannot be explained by drug abuse or medication use

How is it treated?

Treatment for schizoaffective disorder involves:

• medications, like mood stabilizers, antidepressants, and antipsychotic medications
• psychotherapy, including cognitive behavioral therapy and family-focused therapy
• self-management strategies and education

Schizophrenia is a chronic psychiatric condition that affects about 1 percent of the population. This disorder involves disturbances of reality, typically delusions or hallucinations.

It can affect how a person thinks, feels, and behaves. People with schizophrenia often feel like they have lost touch with reality.

What are the symptoms?

Symptoms typically start in the late teens or early 20s. Early symptoms can include:

• isolating oneself from others
• changes in concentration
• changes in social groups
• sleep disturbances
• irritability or agitation
• trouble with school

There are also “positive,” “negative,” and cognitive symptoms. Positive symptoms are symptoms not usually found in people who do not have schizophrenia, including:

• hallucinations
• delusions
• thought disorders
• movement disorders
• disorganized thoughts and behavior

Negative symptoms are changes in behavior, emotions, and the ability to function. These can include:

• disorganized speech
• impulse control problems
• odd emotional responses
• lack of emotional responses
• social isolation
• loss of interest in life
• inability to feel pleasure
• trouble with everyday activities or functioning

Cognitive symptoms are more subtle, but affect memory and thinking:

• impaired executive functioning
• trouble learning information and then using it
• lack of insight about or awareness of their symptoms

How is it diagnosed?

There is no one test for schizophrenia. A psychiatric exam, along with a physical exam, can help a clinician make a diagnosis.

Your doctor will do a physical exam to rule out any physical cause for your symptoms. They will take a medical history, a family history, and a mental health history, asking about your symptoms. Your doctor may also order blood work or imaging tests to rule out any medical causes.

They will also ask you about any medications you take, any substances you use, or any other mental illnesses you have.

To receive a schizophrenia diagnosis, a person must have two or more of the following symptoms, as well as reduced functioning, for at least 6 months:

• hallucinations
• delusions
• negative symptoms
• cognitive issues or disorganized thinking

How is it treated?

Treatment is necessary to control and reduce the severity of the symptoms. Treatment can include:

• first-generation (typical) antipsychotics
• second-generation (atypical) antipsychotics
• psychotherapy, including supportive therapy and cognitive behavioral therapy
• psychosocial treatments, such as peer support groups and assertive community treatment

While they are two different disorders, they do share characteristics, according to a 2014 study. These include:

• presence of positive and negative symptoms
• cognitive impairment
• psychotic symptoms

Based on a 2014 study, the main difference between the two disorders is that schizoaffective disorder is defined by the presence of a mood disorder along with psychotic symptoms. Someone with schizoaffective disorder also must have psychotic symptoms for a period of time without a major mood episode.

Treatment for schizophrenia may not include treatment for a mood disorder, but treatment for schizoaffective disorder includes treating the accompanying mood disorder.

There is no cure for either schizoaffective disorder or schizophrenia, but there are treatment options.

Outlook for schizoaffective disorder

People with schizoaffective disorder may have a better outlook than those with schizophrenia and other psychotic disorders, according to a 2014 study . Treatment is important to help manage the symptoms and improve functioning. How well the treatment works depends on the kind of schizoaffective disorder, its severity, and duration.

Outlook for schizophrenia

Schizophrenia requires lifelong treatment. That being said, with a variety of treatments and supports, it may be possible to manage symptoms.