HOW TO TREAT SCHIZOAFFECTIVE DISORDER 2025

HOW TO TREAT SCHIZOAFFECTIVE DISORDER 2025

GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF COMMON MENTAL DISORDERS

(Enacted under Decision No. 2058/QĐ-BYT dated May 14, 2020, by the Minister of Health)

Article 17

SCHIZOAFFECTIVE DISORDER

CHIEF EDITOR

Associate Professor, PhD Nguyễn Trường Sơn

CO-EDITOR

Associate Professor, PhD Lương Ngọc Khuê

PhD Nguyễn Doãn Phương

CONTRIBUTING AUTHORS

PhD Trần Thị Hà An

MSc Trịnh Thị Vân Anh

PhD Vũ Thy Cầm

MSc Trần Mạnh Cường

PhD Nguyễn Văn Dũng

PhD Vương Ánh Dương

PhD Lê Thị Thu Hà

MSc Trần Thị Thu Hà

MSc Phạm Công Huân

MSc Đoàn Thị Huệ

Specialist Doctor II Nguyễn Thị Minh Hương

MSc Vũ Thị Lan

1. Nguyễn Phương Linh

Specialist Doctor II Nguyễn Thị Phương Loan

MSc Bùi Văn Lợi

MSc Nguyễn Thị Phương Mai

PhD Trần Nguyễn Ngọc

MSc Bùi Nguyễn Hồng Bảo Ngọc

MSc Trương Lê Vân Ngọc

MSc Bùi Văn San

PhD Dương Minh Tâm

MSc Phạm Xuân Thắng

MSc Lê Thị Phương Thảo

MSc Lê Công Thiện

MSc Vương Đình Thủy

Associate Professor, PhD Nguyễn Văn Tuấn

Specialist Doctor II Ngô Văn Tuất

MSc Đặng Thanh Tùng

MSc Vũ Sơn Tùng

MSc Cao Thị Ánh Tuyết

MSc Nguyễn Thị Ái Vân

Specialist Doctor II Hồ Thu Yến

MSc Nguyễn Hoàng Yến

CONTRIBUTORS TO EVALUATION AND FEEDBACK

Associate Professor, PhD Nguyễn Thanh Bình

PhD Vũ Thy Cầm

PhD Nguyễn Hữu Chiến

Specialist Doctor II Võ Thành Đông

PhD Lê Thị Thu Hà

Specialist Doctor II Đỗ Huy Hùng

PhD Nguyễn Mạnh Hùng

MSc Nguyễn Trọng Khoa

Specialist Doctor II Ngô Hùng Lâm

Associate Professor, PhD Phạm Văn Mạnh

Specialist Doctor II Trần Ngọc Nhân

PhD Dương Minh Tâm

MSc Đặng Duy Thanh

PhD Vương Văn Tịnh

Specialist Doctor II Lâm Tứ Trung

PhD Lại Đức Trường

PhD Cao Văn Tuân

Associate Professor, PhD Nguyễn Văn Tuấn

SECRETARIAT TEAM

MSc Đặng Thanh Tùng

MSc Trương Lê Vân Ngọc

BA Đỗ Thị Thư

Article 17

SCHIZOAFFECTIVE DISORDER

I. DEFINITION  

Schizoaffective disorder is characterized by prominent emotional symptoms (mania, depression) and schizophrenic symptoms occurring simultaneously or within a few days of each other during the same episode. The disorder progresses in episodes, with periods of remission between episodes, and has a tendency toward chronicity.

II. ETIOLOGY  

The precise cause and pathogenesis of schizoaffective disorder remain unclear. It is classified as an endogenous disorder influenced by multiple factors, including genetics, immunity, and toxicity.

III. DIAGNOSIS  

1. Diagnostic Criteria  

Schizoaffective disorder meets the full criteria for a moderate to severe mood disorder (F30, F31, F32) alongside schizophrenic symptoms persisting for at least 2 weeks, including at least one of the following:  

1. Thought Echo, Insertion, or Broadcasting:Hearing thoughts aloud, feeling thoughts imposed or stolen.  
2. Delusions of Control or Passivity: Beliefs of being controlled or influenced.  
3. Hallucinatory Voices: Commentary or discussions about the patient, or voices from body parts.  
4. Persistent, Culturally Inappropriate Delusions:Implausible beliefs.  
5. Incoherent or Neologistic Speech:Irrelevant or invented language.  
6. Catatonic Behavior: Posturing, waxy flexibility, negativism.  

– Symptoms must not be attributable to organic brain disease or substance-induced psychosis.

2. Clinical Subtypes (ICD-10)  

– Schizoaffective Disorder, Manic Type:  

  – Meets general criteria for schizoaffective disorder.  

  – Meets criteria for mania (F30.1 or F31.1).  

– Schizoaffective Disorder, Depressive Type:  

  – Meets general criteria for schizoaffective disorder.  

  – Meets criteria for moderate to severe depression (F31.3, F31.4, F32.1, or F32.2).  

– Schizoaffective Disorder, Mixed Type:  

  – Meets general criteria for schizoaffective disorder.  

  – Meets criteria for bipolar mixed episode (F31.6).  

– Other/Unspecified Schizoaffective Disorder:  

3. Differential Diagnosis  

– Schizophrenia: Features characteristic psychotic symptoms (delusions, hallucinations) without simultaneous typical mood symptoms (depression, mania).  

– Bipolar Disorder with Psychotic Features: Prominent mood symptoms (depression, mania) without typical schizophrenic psychotic symptoms.

4. Ancillary Testing  

4.1. Basic Labs  

– Blood: Hematology, biochemistry, microbiology (HIV, HBV, HCV).  

– Urine: General analysis, drug screening, syphilis serology.  

4.2. Imaging/Functional Tests  

– Chest X-ray, abdominal ultrasound.  

– EEG, ECG, cerebral blood flow, transcranial Doppler.  

– CT/MRI brain (select cases).  

4.3. Psychological Assessments  

– PANSS (Positive and Negative Symptom Scale).  

– Personality: EPI, MMPI.  

– Others: BDI, Zung, HDRS, HARS, HAD, MMSE.

IV. TREATMENT  

1. Treatment Principles  

– Early detection and treatment, focusing on pharmacotherapy and psychotherapy.  

– Pharmacotherapy is key, combined with psychotherapy, occupational therapy, and social reintegration.  

– Start with monotherapy; if response is poor, use combination therapy.  

– Monitor drug use closely to manage side effects promptly.  

– Educate families/communities to reduce stigma and foster collaboration with healthcare providers.  

– Address relapse triggers; maintain treatment post-acute phase with community monitoring.

2. Treatment Framework  

– Pharmacotherapy alongside psychotherapy and community rehabilitation.

3. Specific Treatments  

3.1. Pharmacotherapy  

– Antipsychotics: 1-3 agents (prefer monotherapy; switch or combine up to 3 if ineffective):  

  – Typical:  

    – Chlorpromazine (25 mg tabs/vials; 50-250 mg/24h).  

    – Levomepromazine (25 mg tabs; 25-250 mg/24h).  

    – Haloperidol (1.5-5 mg tabs, 5 mg vials; 5-30 mg/24h).  

    – Thioridazine (50 mg tabs; 100-300 mg/day).  

  – Atypical:  

    – Amisulpride (50-400 mg tabs; 200-800 mg/24h).  

    – Clozapine (25-100 mg tabs; 50-800 mg/24h).  

    – Risperidone (1-2 mg tabs; 1-12 mg/24h).  

    – Olanzapine (5-10 mg tabs; 5-60 mg/24h).  

    – Quetiapine (50-300 mg tabs; 600-800 mg/day).  

    – Aripiprazole (5-30 mg tabs; 10-30 mg/day).  

– Antidepressants: 1-3 agents (prefer monotherapy; switch or combine up to 3 if ineffective):  

  – SSRIs:  

    – Fluoxetine (20 mg; 10-40 mg/day).  

    – Paroxetine (20 mg; 20-60 mg/day).  

    – Sertraline (50 mg; 50-200 mg/day).  

    – Fluvoxamine (100 mg; 100-300 mg/day).  

    – Escitalopram (10-20 mg; 10-20 mg/day).  

    – Citalopram (10-60 mg/day).  

  – Dual-Acting:  

    – Venlafaxine (37.5 mg; 75-225 mg/day).  

    – Mirtazapine (30 mg; 30-60 mg/day).  

  – Tricyclics:  

    – Amitriptyline (25 mg; 50-100 mg/day).  

    – Clomipramine (25 mg; 50-75 mg/day).  

    – Imipramine (10-150 mg/day).  

  – Other: Tianeptine (12.5-50 mg/day).  

– Mood Stabilizers: 1-2 agents (prefer monotherapy; switch or combine up to 2 if ineffective):  

  – Valproate (200-2500 mg/day).  

  – Divalproex (750 mg/day to 60 mg/kg/day).  

  – Carbamazepine (400-1200 mg/day).  

  – Oxcarbazepine (1200-2400 mg/day).  

  – Lamotrigine (100-400 mg/day).  

  – Topiramate (50-400 mg/day).  

  – Gabapentin (300-1800 mg/day).  

– Treatment by Subtype:  

  – Depressive Type: Combine antipsychotics and antidepressants.  

    – Adjuncts: Benzodiazepines (diazepam, lorazepam, bromazepam, alprazolam), non-benzodiazepines (etifoxine, zopiclone), beta-blockers (propranolol), mood stabilizers (valproate, divalproex, lamotrigine), neuroprotectants (piracetam, ginkgo biloba, vinpocetine, choline alfoscerate, nicergoline), nutrition (B vitamins, minerals, IV feeding), hepatic support, cognitive enhancers.  

  – Manic Type: Combine antipsychotics and mood stabilizers.  

    – Adjuncts: Benzodiazepines, non-benzodiazepines, beta-blockers, neuroprotectants, nutrition, hepatic support, cognitive enhancers.  

  – Mixed Type: Combine antipsychotics and mood stabilizers.  

    – Adjuncts: Benzodiazepines, non-benzodiazepines, beta-blockers, antidepressants (SSRIs, SNRIs, mirtazapine), neuroprotectants, nutrition, hepatic support, cognitive enhancers.  

– Monitoring:  

  – Side Effects:  

    – Extrapyramidal symptoms: Cholinesterase inhibitors (trihexyphenidyl, benztropine), beta-blockers, sedatives.  

    – Neuroleptic malignant syndrome/serotonin syndrome: Early detection, ICU management.  

    – Metabolic disorders: Monitor BMI, blood tests every 3-6 months.  

    – Clozapine: White blood cell count every 3 months.  

    – Tardive dyskinesia: Muscle relaxants, sedatives, vitamin E, anticholinergics.

3.2. Psychotherapy  

– Individual, family, or group therapy to support patients through psychological crises, enhance illness insight, stabilize family dynamics, and aid community reintegration.

3.3. Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS)  

– ECT: Effective for catatonia, suicidal behavior due to depression, treatment-resistant delusions/hallucinations, or agitation.  

– TMS: Useful for persistent auditory hallucinations or depression.

3.4. Occupational and Rehabilitation Therapy  

– Start activities at the patient’s capability level to rebuild confidence, gradually increasing intensity without causing stress.  

– Tailor vocational rehabilitation to socio-economic-cultural context.

3.5. Physical Therapy and Community Management  

– Ongoing monitoring and treatment in the community.

V. PROGNOSIS AND COMPLICATIONS  

– Risk increases with a family history of schizophrenia, schizoaffective disorder, or bipolar disorder.  

– Suicide is a significant potential complication.

VI. PREVENTION  

– Exact cause unknown, so prevention focuses on:  

  – Fostering independence and adaptability to life’s challenges.  

  – Reducing stress through sharing and coping strategies.  

  – Monitoring individuals with a family history of schizophrenia or related disorders for early detection and treatment.  

  – Post-discharge follow-up, sustained specialist treatment, avoiding overexertion/stress, and proactive management of physical illnesses to prevent relapse.

REFERENCES

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