Developing an Individualized Treatment Plan for Patients With Schizoaffective Disorder: From Pharmacotherapy to Psychoeducation

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.

From the Bipolar Disorders Program and the Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.

This article is derived from the planning teleconference series "New Approaches to Managing Schizoaffective Disorder From Diagnosis to Treatment," which was held in June 2010 and supported by an educational grant from Janssen, Division of Ortho-McNeill-Janssen Pharmaceuticals, Inc. administered by Ortho-McNeil Janssen Scientific Affairs, LLC.

Dr Vieta is a consultant for and has received honoraria from Almirall, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson, Eli Lilly, Merck Sharp & Dohme, Otsuka, Pierre Fabre, Pfizer, Sanofi-Aventis, Servier, United Biosource Corporation, and Wyeth; has received grant/research support from Almirall, AstraZeneca, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Janssen-Cilag, Eli Lilly, Otsuka, Pfizer, Sanofi-Aventis, Servier, Spanish Government, Catalan Government, 7th European Framework Programme, and SENY Foundation; and is a member of the speakers/advisory boards for AstraZeneca, Bristol-Myers Squibb, Forest, Janssen-Cilag, Jazz, Eli Lilly, Lundbeck, Merck Sharp & Dohme, Otsuka, Pfizer, Sanofi-Aventis, Servier, Shering-Plough, Takeda, United Biosource Corporation, and Wyeth.

Corresponding author: Eduard Vieta, MD, PhD, University of Barcelona, Director of the Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, Villarroel 170, 08036 Barcelona, Catalonia, Spain (evieta@clinic.ub.es).