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
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
If you or a family member or friend is experiencing challenges related to schizoaffective disorder, there is help. NAMI is here to provide support for you and your family and information about community resources. NAMI offers a variety of information and programs tailored to the specific needs of people experiencing these conditions and their family members. These programs are all led by people with their own personal experience with these conditions which makes the information they are sharing even more powerful.
To learn more about these programs visit www.nami.org/programs or contact the NAMI HelpLine at 1-800-950-NAMI (6264) or [email protected] if you have any questions about psychosis or finding support and resources. You can also use the Find Your Local NAMI tool to find a NAMI in your own community.
Helping Yourself
There are many ways to help manage symptoms of schizoaffective disorder to help keep symptoms from getting worse and reduce the chance of experiencing a mental health crisis:
- Pinpoint your stressors. Are there specific times when you find yourself stressed? People, places, jobs, and even holidays can play a big role in your mood stability. Symptoms of mania and depression may start slow, but addressing them early can prevent a serious episode. And although feelings of mania may feel good at first, they can spiral into dangerous behavior such as reckless driving, gambling or hypersexuality. Depression may begin with feeling tired and being unable to sleep.
- Avoid drugs and alcohol. Substance use can disturb emotional balance and interact with medications. Both depression and mania make drugs and alcohol attractive options to help you “slow down” or “perk up,” but the consequences can set back your recovery.
- Establish a routine. Committing to a routine can help you manage symptoms and feel more in control. For example, to keep the energy changes caused by depression and mania in check, commit to a regular sleep wake cycle that can help you regulate your natural body rhythms. The same can be true for exercising at predictable times of the day, again, to help regulate natural body rhythms.
- Form healthy relationships. Relationships can help stabilize your mood. An outgoing friend might encourage you to get involved with social activities and lift your feelings of sadness or low energy. A more relaxed friend may provide you with a steady calm that can help keep feelings of mania under control. If you feel you can, consider connecting with others through online message boards, peer-education programs like NAMI Peer-to-Peer, or peer support groups like NAMI Connection. You can also get involved with a local church club or other organization.
- Self-management strategies and education. Learning strategies to manage the symptoms of your disorder is critical. Coping strategies may also include work and school support and social skills training.
- Partner with your health care providers. Give your health care provider all the information they need to help you recover – including any reactions to medications, your symptoms or any triggers you notice. Develop trust and communicate openly. If you don’t feel comfortable with your provider, that’s okay, too. Not all providers will be a good fit for everyone. Consider exploring other options – you might try to find providers that share your cultural background or have worked with people who have similar experiences.
- Consider sharing your story. When you are ready there can be great power in helping others and yourself when you share your experience. This can be done in a confidential support group or on larger public platform as you see fit.
- Know what to do in a crisis. Be familiar with your community’s crisis hotline or emergency walk-in center. Know how to contact them and keep the information handy. Wherever you are, you can call or text or chat 988, the national Suicide & Crisis Lifeline, 24 hours a day, 7 days a week for support during a mental health crisis.
If you live with a mental health condition, learn more about managing your mental health and finding the support you need.
Helping A Family Member or Friend
Understanding how to support someone with schizoaffective disorder is not only helpful for the person’s recovery, but also for your own mental well-being. Here are some tips:
- Recognize early symptoms.You may be able to help prevent a serious episode of the illness before it happens. Symptoms of mania, depression and psychosis often have warning signs. You can learn from prior episodes to help your loved one identify the onset of an episode of symptoms they may not be able to themselves. The beginnings of mania typically feel good and that means your family member may not want to seek help. Identify signals such as lack of sleep and speaking quickly. A deep depression often begins with a low mood, feeling fatigued or having trouble sleeping.
- Communicate. This can be challenging at times for most family members. Finding ways to communicate about your loved one’s experience together is essential if not always easy. Make time to talk about problems but also know that not just any time is the right time. For example, you might know that your family member can engage in difficult conversations even when they’re angry. Or, you might know that it’s best to wait until your family member has had time to calm down to avoid a more stressful or even dangerous situation.
- Awareness of illness (also referred to as anosognosia) can present a challenge with schizoaffective disorder as well as schizophrenia and mood disorders. Xavier Amador’s book, I Am Not Sick I Don’t Need Help, is a guide that can be helpful in these situations.
- Sometimes getting a person to seek help is the challenge. It can be difficult to help someone who doesn’t recognize that they’re experiencing symptoms or who may feel afraid or mistrustful of treatment. This can be frustrating and painful for family members and friends who only want to help. Try to stay patient and supportive, even when progress feels slow. Focus on building trust, listening without judgment, and expressing care and concern. Learning more about the illness and available treatment options can also help you feel better equipped to provide encouragement and hope along the way. Motivational interviewing is a research-backed approach to help communicate with someone who is struggling to accept help. This technique was initially developed to help those living with substance use disorder but has broadened considerably and we have learned that the techniques used can be helpful for family members as well as trained therapists.
- React calmly and rationally. Even in situations where your family member or friend may start to yell or lose their temper, it’s important to remain calm. Listen to them and make them feel understood, then try to work toward a positive outcome.
- Help ensure medications are taken as prescribed. Many people question whether they still need medication when they’re feeling better or if there are unpleasant side effects. Encourage your loved one to take their medication regularly to prevent symptoms from coming back or getting worse. If it seems like side effects are really bothering them, you can suggest they speak to their health care provider to see if there are any other options.
- Help reduce or avoid use of recreational drugs and alcohol. These substances are known to worsen schizophrenia symptoms and trigger psychosis and are likely to worsen schizoaffective disorder as well. If your loved one develops a substance use disorder, getting help is essential.
Additional Resources
- Catatonia is a neuropsychiatric condition involving abnormal movements, behaviors, and speech that can be associated with psychosis (and other mental health conditions). For information and resources on catatonia, visit the Catatonia Foundation.
- For advice from professionals, advocates, and other NAMI experts related to schizoaffective disorder and other mental health topics, view past recordings of NAMI’s Ask the Expert series. Presentations that may be particularly useful include:
- For stories from real people about their experiences with mental health, including schizoaffective disorder, check out NAMI’s book series: You Are Not Alone: The NAMI Guide to Navigating Mental Health and You Are Not Alone for Parents and Caregivers: The NAMI Guide to Navigating Your Child’s Mental Health.
- Learn how to have more effective, empathetic conversations about mental health conditions that include psychosis with NAMI’s Schizophrenia and Psychosis Lexicon Guide. This resource merges professional insights with lived experiences to recommend language that conveys respect, understanding, and support — helpful for clinicians, family members, the media, and the general public. Learn more and download the guide here.
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Reviewed and updated December 2025
