Schizo-affective: What's the difference?

My psychiatrist claims schizo-affective has a better prognosis than typical schizophrenia. That the mood disorder componant means I’m better than plain old schizophrenia, or paranoid schizophrenia. I’m really confused. Recently, my therapist suggested that they were changing it to Bipolar disorder, and the DSM was doing away with schizoaffective, the next week my psychiatrist said she hadn’t been informed of this. I haven’t had symptoms since I was seventeen, I’m twenty-three now.

What’s bugging me is that I don’t think I have a mood disorder, but they’re telling me this is a better diagnosis than schizophrenia. I’ve never really had highs to the extreme or lows of depression. I feel on the defensive about this, but I don’t know how to approach my psychiatrist and therapist. Do I even sound schizophrenic? I don’t seem that way to my friends. I can’t seem to figure out what’s wrong with me. I guess they are having the same problem. I’m not sure though. I’m sick of being told labels dont matter, because they do to me.

I want them to be accurate. If I have schizophrenia then I have schizophrenia, if it’s wrong than why am I being treated and what’s been going on for the past seven years?
Obviously something went wrong in my behavior and thinking. I was treated beginning age fifteen and diagnosed at sixteen or seventeen years old with schizophrenia then schizoaffective, because I wanted anti-depressants to combat the effect of anti-psychotics. I’m feeling really frustrated. I hate the word schizophrenia, it never seemed to fit me. But I hate the idea of a mood disorder as if it would justify anything. I really don’t know what’s wrong with me.

I was in college for 2 years, had a high GPA freshman year of a 3.57 and was on the dean’s list. I take medication, just one and it’s an anti-psychotic. Is schizoaffective better or worse than schizophrenia? Is schizoaffective better or worse than bipolar disorder? Should they change my diagnosis to bipolar? Or is it ok to call it schizophrenia? What really is the major difference and why am I so confused?

Basically, are they wrong about this label? How do I get the right label when these are good doctors…but I’m not conveying things right to them. I just went along with the therapist about the mania recently, which she assumes I am treating???

a) The psych profession’s Diagnostic and Statistical Manual gives one the impression that mental illnesses are very well understood, with very specific diagnostic codes (with DECIMAL POINTS, no less!!).

b) The reality is that for the first 3/4 of the profession’s history, they kept getting raided by OTHER branches of the medical profession any time anyone actually figured out what was causing a “mental illness”. That left only the things that the late 19th thru mid 20th century had been unable to figure out scientifically. This was in part because institutional psychiatry, mainstream practice psychiatry (in other words: NOT private practice Freudian psychoanalysis), was not highly regarded within medicine. When one certain dementia turned out to be caused by an infection (syphilis) it could have remained under the auspices of psychiatry but with an actual cure and prevention strategy it was snapped up by the internal medicine / infectious diseases folks. Likewise when certain forms of epilepsy and thyroid conditions at either extreme were understood to be at the root of various other things formerly categorized as “mental illnesses”, they could have remained so classified (being mental illnesses that now had an understood physical etiology) but they weren’t — patients and the families thereof were far more comfortable going to a neurologist or an endocrinologist than to a psychiatrist.

c) The insurance companies demand diagnostic codes and will cover tretaments only as are considered typical and appropriate for the diagnosis. This has reinforced the technical, “we know what it is” aspect of DSM psych diagnoses.
We do NOT, in fact, understand most of these ailments with anywhere near the clarity and specificity implied by these categories. We’re only a smidgen better than "Mental illness can be divided up into ‘how you feel is all messed up’, ‘how you think is all messed up’, and ‘we don’t know what’s up with you but we find you disturbing’ ".

I’ve had both diagnoses (schizophrenia and schizo-affective disorder) plus schizoTYPAL disorder plus manic-depressive (the old name for bipolar disorder). I know you don’t want to hear “labels don’t matter” but that’s because you’d like to understand what’s going on with you. That’s an entirely understandable attitude and desire, but as of 2012 the labels are just aliases for generalizations about symptoms. We don’t know what causes any of the schizzy stuff (or any of the other major categories for that matter). The pills are not carefully and cleverly designed to intervene for this specific diagnosis and not that one and there’s evidence at this point that they aren’t even very good at reducing symptoms if taken over the long term.

Thank you for such a clear and helpful answer. It seems the psychiatrist is just giving me her most educated opinion on a highly misunderstood illness. The DSM 5 looks like it might be better than the older one, either way it will be interesting to see where it leads us. I guess I’m going to have to ignore the labels, even if they don’t always make sense. Have you watched any TED talks by Elyn Saks? I don’t think she is the only person with this illness that is successful, but definitely one of the few to come out in the open about it.

I haven’t. I’m one of those annoying no-TV-service snobs :slight_smile: But I’ll try to check it out. I’m a schizzy libber and it’s nice to see more people refusing to be hidden away.

I am not a physician. But I think that the fact that you’re not saying “there’s nothing wrong with me, they’re just out to get me” indicates either that (a) you’re not schizophrenic, or (b) if you are, you probably have a good prognosis.

As AHunter3 indicates, diagnosis of conditions such as schizophrenia is not an exact science. I think about the only indicator that’s considered really diagnostic is auditory hallucinations. (That is, not all people with schizophrenia hear voices, but if a person does hear voices, you can pretty well deduce that they have schizophrenia.)

Not that there’s anything wrong with that, necessarily.

I’ve known schizzies who get the voices and they just adjust to them as part of their everyday reality and COPE with everyday reality to their own and (for the most part) external world’s satisfaction.

I’ve been told by a psychiatrist and an advanced practice psych nurse that it is untrue that anyone who hears voices is schizophrenic. (This was not because I was hearing voices, but because I had a job that involved working with a population with high rates of mental illness.)

Medical advice is best suited to IMHO.

General Questions Moderator

Don’t worry about the label. It’s only useful in so much as it helps guide them towards the right family of medications. AHunter3 is right in that sense.

Also, the TED Talks that Kalinda refers to are all online.

That is not true. Hallucinations can also be symptoms of depression, bipolar, and I think a couple other disorders. Or there can be physical causes.

I see this is correct. Wikipedia says schizophrenia is the primary cause, but there are numerous others.

I wouldn’t be surprised if a lot more people have auditory hallucinations than admit it, which is a result of the ‘hallucinations=crazy’ way of thinking, but also a cause of it since people don’t hear much about normal-seeming people experiencing it.

I have to say it blows my mind when people with these diagnoses come in and make perfectly rational posts. My uncle is schizoaffective with paranoid delusions and he’s barely coherent. All he does is smoke cigarettes and drink coffee. He’ll get maybe two sentences out before he delves into Government Conspiracy Alien Drug Operatives territory. He gets cheesecake and dead bodies in his ciagarettes, and his casettes are laced with LSD. He can barely function. The only time he’ll agree that he’s mentally ill is if he wants to get out of doing something, but he doesn’t actually believe it. My entire life, he has been balls-out insane and forever on the verge of homelessness.

So just… I don’t know. I’ll say that people like the OP are definitely broadening my view of mental illness. I think labeling can be helpful for a few reasons:
a)finding other people going through the same thing
b)researching or implementing a specific treatment

Other than that, it’s really just most important that you are able to cope with everyday life. I would focus more on the quality of your life than needing to nail down a specific thing to call yourself.

Thanks guys for the helpful comments,

I know a lot about different mental disorders. I did a lot of research growing up to understand what was going on and I’m realizing that Bipolar with some psychotic features makes sense, which was what my therapist was describing. I think one way to understand Bipolar is that your brain is over-active, but it’s still a misunderstood illness. It can interrupt a normal life, and both illnesses really just suck.

What I have read and been told is that with Bipolar, the sooner you treat it the less damage it does and the more productive you can be over time.

Olivesmarch4th, perhaps your Uncle didn’t have as good treatment then or has not had the successful treatment that some do. Also, I am one of the rare people that have returned to almost full remission on medication. But there are a lot of people with MI who lead functional lives, so it may not be as rare as the media predicts. This is because of stigma, and people being afraid to come forward in the first place.


You might be right about some people being able to cope with voices. I do not hear them, but I have on occasion had those gut instincts or intuitive helping voices in the past or off medication. They are not stereotypically annoying or bad. Sometimes they can be insightful remindors that the conscoius mind doesn’t realize. I think for some hearing voices can be a coping mechanism. But the reasons for hearing a voice or a sound are very diverse.

My quality of life is improving a lot, but there are still some things that I’d like to make better, for instance finish college. I’ve gone for 2 years and I’m thinking of going back this semester.

Nope. Not only are there other mental and physical illnesses which can cause auditory hallucinations (as already’s been said) but most researchers agree that anywhere from 7 to 50% of “normal” people without any illness at all will experience auditory hallucinations at least once. (Yes, that’s a ridiculously wide range, but research is difficult when people are afraid that answering honestly may get them labelled a weirdo at best and mentally ill at worst.)

I have several patients with Diabetes Mellitus Type II who take one pill a day to control their blood sugar and never go above 150. I have another who takes seven insulin injections of three different types (long acting, fast acting AND 70/30) and 6 pills of two different oral meds and she’s still in the dangerous range of blood sugars for most of the day. Some people are sicker than others, even with an unambiguous diagnosis.

AHunter3, I may just bookmark your first reply in this thread. Very well written, thank you.

Auditory hallucinations can also be caused by so-called “medicines.” The doctors had my niece on some fool drug or other several years ago and she started hearing voices. It was a long time before anyone figured out that the drugs were causing them. They stopped shortly after she discontinued the drug.