Developing an Individualized Treatment Plan for Patients With Schizoaffective Disorder

Bipolar Disorders Program and the Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 12/2010; 71 Suppl 2(suppl 2):14-9. DOI: 10.4088/JCP.9096su1cc.03
Source: PubMed


To develop an individualized treatment plan that addresses both psychotic and affective symptoms in patients with schizoaffective disorder, clinicians can take several steps. First, clinicians can confirm the diagnosis. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and in the International Classification of Diseases, Tenth Revision (ICD-10), schizoaffective disorder is defined differently, but, diagnostically, the disorder falls on a spectrum between bipolar disorder and schizophrenia and can be divided into bipolar and depressive types. Next, clinicians can evaluate predictors of outcome. Outcomes can be predicted by previous functioning, number of previous episodes, persistence of psychotic symptoms, and level of cognitive impairment. Then, clinicians can use evidence from clinical trials to guide selection of acute and maintenance phase treatment. Although data are limited, direct and indirect evidence from clinical trials support pharmacologic and psychoeducational interventions. In bipolar type schizoaffective disorder, evidence supports the use of an atypical antipsychotic and a mood stabilizer or atypical antipsychotic monotherapy. In the depressive type of the disorder, the combination of an atypical antipsychotic and an antidepressant is probably the best choice, but an atypical antipsychotic and a mood stabilizer could also be used. In both types of the disorder, patient psychoeducation can be beneficial in the maintenance phase of treatment. Adherence to treatment is essential for optimal outcome, and, besides patient psychoeducation, long-acting injectable antipsychotics and psychoeducation for caregivers may also improve adherence. In refractory cases, electroconvulsive therapy is an option.

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    • "Many patients with BD and SCZ are initially misdiagnosed especially in the early stages of both disorders (Young, 2009). The diagnostic difficulties between them are common (Vieta, 2010). The consequences of misdiagnosis can include worsening of manic or depression symptoms, increased drug resistance, reduced quality of life, and increased risk of suicide (Young, 2009). "
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    ABSTRACT: The Parental Bonding Instrument (PBI) examines parent-child bonds and attachment during the first 16years. Our study aims to compare PBI scores between patients with schizophrenia and bipolar disorder (BD). We analyzed PBI scores in 59 patients with schizophrenia, 36 with BD and 52 healthy controls using ANCOVA, with age, gender and years of education as covariates. Bonferroni correction was used to adjust for multiple comparisons. PBI has maternal and paternal scores, each one with two domains: care and overprotection. In PBI maternal and paternal care domains, patients with schizophrenia showed significantly higher scores when compared with BD patients (p<0.001). However, when compared with healthy controls, patients with schizophrenia only showed significantly higher scores of PBI maternal care domain (p=0.037). BD patients showed significantly lower PBI care scores compared with healthy controls (maternal score: p=0.016; paternal score: p<0.001). In PBI maternal and paternal overprotection domain, BD patients showed significantly higher scores compared with patients with schizophrenia (p=0.004; p=0.021) and healthy controls (p=0.014; p=0.008); while no significant difference was observed between patients with schizophrenia and healthy controls. "P values" are according to Bonferroni correction. There are significant differences in the perception of attachment between schizophrenia and BD. This finding may shed some light to better understand the prodromal symptoms of each disorder. Copyright © 2015 Elsevier B.V. All rights reserved.
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    • "The majority of AP drugs can be classified as either typical or atypical APs. Generally, atypical APs are the preferred class of drugs as they demonstrate improvements on a variety of symptoms with fewer side effects than typical APs (Vieta, 2010). However, AP medication, regardless of class, may have undesirable side effects or ineffective responses. "
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    ABSTRACT: Objective: To improve antipsychotic treatment in schizophrenia patients, many studies have investigated genetic polymorphisms associated with antipsychotic metabolizing enzymes and receptors. While these studies have typically focused on drug response, few have investigated genetic influences on antipsychotic dosage. This study set out to analyze the association between 134 SNPs in 38 candidate genes and antipsychotic dosage in schizophrenia patients. Methods: For our analysis, 300 patients with a diagnosis of either schizophrenia or schizoaffective disorder were recruited between the ages of 18 and 75. A cross-sectional assessment was used, in which data were collected from each participant through an interview and self-report questionnaire. Antipsychotic dose was standardized according to the chlorpromazine equivalents, defined daily dose and relative to the maximum dose specified in the product monograph. Participants were genotyped using a Customized Illumina Chip comprising 134 SNPs, and all markers were screened for nominal significance. Results: The analysis showed a nominally significant association with the GFRA1 gene. Conclusion: The common variants investigated in this study had no major influence on the antipsychotic dosage prescribed in study participants. It remains, though, that this strategy may prove valuable clinically and warrants further investigation.
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    • "3/3 of measures indicating proper adherence) or " poor " (2/3, 1/3 or 0/3 measures indicating proper adherence) adherence definition. This extensive evaluation followed previous publications in the field (Colom et al., 2000; Vieta et al., 2011b; Velligan et al., 2010). Adherence to treatment was cross-sectionally evaluated between August and September, 2011. "
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