Schizoaffective Disorder

Schizoaffective disorder is a serious mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions, along with symptoms of a mood disorder, such as mania and depression.

Many people with schizoaffective disorder are often incorrectly diagnosed at first with either bipolar disorder or schizophrenia. Because schizoaffective disorder is less well-studied than the other two conditions, many of the interventions used actually were developed for those treatment approaches — but have demonstrated effectiveness in schizoaffective disorder.

Schizoaffective disorder is relatively rare, with a lifetime prevalence of 0.3%. Men and women experience schizoaffective disorder at the same rate, but men often develop the illness at an earlier age. Schizoaffective disorder can be managed effectively with a combination of medication and therapy. It’s common for people with this condition to also experience substance use disorders which require an integrated treatment.

Causes

The exact cause of schizoaffective disorder is unknown. A combination of causes may contribute to its development, a few of which include:

• Genetics. Schizoaffective disorder tends to run in families. This does not mean that if a relative has an illness, you will absolutely get it. But it does mean that there is a greater chance of you developing the illness. Additionally, studies have found that people who have a family history of schizophrenia or mood disorders are at increased risk for developing schizoaffective disorder. It’s important to be aware that most people with these family histories do not develop these conditions.
• Brain chemistry and structure. Brain structure and function may differ in ways that science is only beginning to understand. Advances in brain-imaging research are helping us gain a clearer picture of these differences and fortunately are not necessary to develop an effective treatment plan.
• Stress. Stressful events such as a death in the family, end of a marriage or loss of a job can contribute to the development of symptoms or an onset of the illness.
• Drug use. Substance use can increase the risk of developing or worsening symptoms of schizoaffective disorder, particularly in people who are already vulnerable.
  • Hallucinogenic drugs such as LSD or psilocybin (“mushrooms”) can sometimes trigger psychotic episodes that resemble those seen in schizoaffective disorder. Regular marijuana use during adolescence has also been linked to a higher risk of developing psychotic disorders later in life, especially among individuals with a family history or genetic predisposition.
  • Stimulant drugs — including cocaine, amphetamines, and methamphetamine — can also cause or worsen psychotic symptoms. In some cases, stimulant use may lead to temporary psychosis, and in others it may increase the likelihood of developing a longer-term psychotic disorder in those who are already at risk.

Related Conditions

A person with schizoaffective disorder may have additional mental health conditions. Each of these co-occurring conditions requires thoughtful additions to the treatment plan:

• Anxiety disorders
• Posttraumatic stress disorder (PTSD)
• Attention-deficit hyperactivity disorder (ADHD)
• Substance use disorders / Dual Diagnosis

Reviewed and updated December 2025.

The symptoms of schizoaffective disorder can be severe and need to be monitored closely. Depending on the type of mood disorder diagnosed, depression or bipolar disorder, people will experience different symptoms:

• Hallucinations, which are experiencing things that aren’t there — usually seeing, hearing or smelling.
• Delusions, which are false, fixed beliefs that the person holds regardless of contradictory evidence.
• Disorganized thinking: A person may switch very quickly from one topic to another or provide answers that are completely unrelated.
• Depressed mood: If a person has been diagnosed with the depressive type of schizoaffective disorder, they will experience feelings of sadness, emptiness, worthlessness or other symptoms of depression.
• Manic behavior: If a person has been diagnosed with the bipolar type of schizoaffective disorder, they will experience feelings of euphoria, racing thoughts, increased risky behavior and other symptoms of mania.

Reviewed and updated December 2025.

Schizoaffective disorder can be difficult to diagnose because it has symptoms of both schizophrenia and either depression or bipolar disorder. There are two major types of schizoaffective disorder: depressive type and bipolar type. To be diagnosed with schizoaffective disorder a person must have the following symptoms:

• A period during which there is a major mood disorder, either depression or mania, that occurs at the same time that symptoms of schizophrenia are present.
• Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode.

Symptoms that meet criteria for a major mood episode that are present for the majority of the total duration of the illness.

This diagnostic framework involves elements of both conditions, schizophrenia and mood disorders. As with schizophrenia and mood disorders such as bipolar disorder or major depressive disorder, these are symptom-based diagnoses. There are no biomarkers (like blood pressure or sugar levels) to confirm a diagnosis at this time. NAMI has partnered with the Foundation of the National Institute of Health and many other public and private entities to create the Accelerated Medicines Partnership for Schizophrenia (AMP-SCZ). This international coordinated research effort seeks to biologically identify people who are at risk of developing psychosis to help create biomarkers to improve diagnosis and early intervention.

For an accurate diagnosis, the symptoms cannot be attributed to substance use or another medical condition.

Cultural Considerations

Research shows that Black and Latino individuals are more likely to be misdiagnosed with schizoaffective or other psychotic disorders. Factors such as provider bias and limited access to culturally responsive care can all contribute to this disparity. Working with a mental health professional who understands your cultural background and values can help obtain the most accurate diagnosis and effective treatment.

Reviewed and updated December 2025.

People with schizoaffective disorder are often treated with a combination of medications and psychotherapy. How well treatment works depends on the type of schizoaffective disorder, its severity and its duration.

Medications

Psychiatrists, psychiatric nurse practitioners and other mental health professionals will often prescribe medications to relieve symptoms of psychosis, stabilize mood and treat depression. The only medication approved by the FDA to specifically treat schizoaffective disorder is the antipsychotic drug paliperidone (Invega).

However, some medications approved for the treatment of other mental health conditions may be helpful for schizoaffective disorder. These medications include:

• Antipsychotics. A health care provider will prescribe antipsychotics to relieve symptoms of psychosis, such as delusions and hallucinations.
• Antidepressants. When schizoaffective disorder is depressive-type antidepressants can alleviate feelings of sadness, despair and trouble concentrating.
• Mood stabilizers. When bipolar disorder is the underlying mood disorder, mood stabilizers can help stabilize the highs and lows.

It’s important to specifically mention one medication — clozapine (Clozaril), a unique second-generation antipsychotic — because it is the only FDA-approved medication for treatment-resistant schizophrenia (TRS). It is also the only FDA-approved medication to reduce suicidality in people living with schizophrenia. Clozapine has additional blood monitoring requirements and side effects, but remains an underutilized resource for people who have not responded to treatment with at least 2 different antipsychotic medications. Clozapine has been shown to be the most effective medication in these cases.

With the help of families and individuals sharing their experiences, NAMI and other advocacy organizations successfully advocated for a reduction in paperwork and process to access clozapine at the FDA in 2025. This announcement signaled the removal of the risk evaluation and mitigation strategy (REMS) process, which eliminates some of the barriers to clozapine use.

Psychotherapy

Psychotherapy can help people learn to change unhelpful thinking patterns and better manage symptoms and the events that can lead them to occur or worsen.

One common type of psychotherapy is cognitive behavioral therapy (CBT), which focuses on exploring relationships among a person’s thoughts, feelings and behaviors. During CBT a therapist will actively work with a person to uncover unhealthy patterns of thought and how they may be causing self-destructive behaviors and beliefs. Studies of CBT have shown it to be an effective treatment for a wide variety of mental illnesses, including depression, anxiety disorders, bipolar disorder, eating disorders and schizophrenia. Individuals who undergo CBT show changes in brain activity, suggesting that this therapy actually improves your brain functioning as well.

With conditions like schizoaffective disorder that have symptoms of psychosis, additional cognitive therapy is added to basic CBT (CBTp). CBTp helps people develop coping strategies for persistent symptoms that do not respond to medicine.

Other Psychosocial Interventions

Psychotherapy is just one type of psychosocial intervention. Others include peer support — like NAMI’s Peer-to-Peer education program and NAMI Connection support group — integrated care for co-occurring substance use disorders, self-care practices and family involvement. To learn more about these programs and others available from NAMI visit www.nami.org/programs.

Individual Placement and Support (IPS) is an evidence-based supported employment approach designed to help people with mental illness locate jobs that match their strengths and interests. Once an individual finds a job, IPS programs provide continuous support to overcome obstacles and succeed in the workplace. IPS teams are a partnership between employment specialists, mental health care providers and the person with mental illness. Based on the person’s choice, family or friends may be included in the team. Employment specialists help individuals identify goals and, together with the team, work toward achieving them. To learn more about IPS visit https://ipsworks.org/.

Alternative Treatment Options

For cases where medication and psychotherapy do not work for a person with schizoaffective disorder, ECT may be worth considering. ECT is a non-invasive medical treatment that is most often used with individuals who have a serious mental illness, such as major depression or bipolar disorder. It’s performed under anesthesia and involves using small electric currents to trigger a brief, controlled seizure in the brain. ECT appears to create changes in brain chemistry that can quickly improve certain mental health symptoms.

Reviewed and updated December 2025.

Related blog posts

• Transcending the Self-Stigma From my Youth

Reviewed and updated December 2025.