A retrospective naturalistic study on the psychopharmacological treatment of schizoaffective disorder

Abstract

Evidence on the effectiveness of psychopharmacological treatment of schizoaffective disorder is scarce and mostly comes from indirect, nonspecific sources. We carried out a large retrospective study (n = 770) of every other consecutively numbered clinical record with a recorded ICD-10 diagnosis of schizoaffective disorder in the Andalusian Health Service record system. We gathered sociodemographic, drug treatment and clinical outcomes such as improvement, relapses and change over time on DSM-5 psychotic dimensions. We analyzed data to explore associations between drug use and clinical improvement. Antipsychotics were the most commonly used drugs (77%). 22.4% of patients experienced at least a mild improvement. Clozapine (odds ratio [OR] = 2.4) and aripiprazole (OR = 2.3) for global improvement, and quetiapine (OR = 3.5) for depression were the most effective drugs. Antidepressants, mood stabilizers and benzodiazepines were also associated with a better outcome in some DSM-5 dimensions such as delusions, hallucinations and language, respectively. Antipsychotic monotherapy was not associated with a better outcome. Our findings corroborate the role of antipsychotics as the essential psychopharmacological treatment for different symptoms of schizoaffective disorder. However, the role of mood stabilizers, antidepressants or BZD is controversial and should be individually considered. Int

Mood Disorder or Psychotic Disorder? Yes: A Case Report on Cycloid Psychosis

“…When compared with these 3 disorders, the Perris and Brockington criteria were found to have the highest concordance rate with the original 3-subtype description of cycloid psychosis delineated by Karl Leonhard, supporting the concept as clinically useful and distinct 17 . We break down these 3 disorders, using DSM-5 and ICD-10 criteria where available for clinical relevance, 18,19 and compare them with the Perris and Brockington diagnostic criteria of cycloid psychosis in Table 2 4,20,21 . Unlike brief psychotic disorder, a mood component can fulfill the criteria for cycloid psychosis, and the duration of the episode is not limited to less than 1 month.…”

“…17 We break down these 3 disorders, using DSM-5 and ICD-10 criteria where available for clinical relevance, 18,19 and compare them with the Perris and Brockington diagnostic criteria of cycloid psychosis in Table 2. 4,20,21 Unlike brief psychotic disorder, a mood component can fulfill the criteria for cycloid psychosis, and the duration of the episode is not limited to less than 1 month. Unlike acute and transient psychotic disorder, meeting the criteria for a major mood disorder will not exclude the diagnosis of cycloid psychosis, and it is also not restricted to a duration of 3 months.…”

“…Comparison of Brief Psychotic Disorder, Acute Transient Psychotic Disorder, and Schizoaffective Disorder With Cycloid Psychosis4,20,21 …”

The challenge of managing difficult to treat psychiatric conditions

“…Treatment-resistant schizophrenia is relatively uncommon, but it is another quite challenging condition given the few treatment strategies available. Clozapine is the standard treatment given that proved to be the most effective medication for resistant schizophrenia and schizoaffective disorder (Muñoz-Negro et al , 2021); however, due to its tolerability profile, it is usually underused (Correll and Howes, 2021). Moreover, some patients do not respond even to clozapine and need alternative treatments (Watanabe et al , 2021) or combinations with long-acting antipsychotics (Caliskan et al , 2021).…”