The distinction between bi-polar and schizophrenia was originally intended to capture different courses of illness (for the most part. People with schizophrenia were thought to be chronic such that they couldn't go on to live productive lives whereas the course of bi-polar was thought to be intermittent such that people had episodes of good functioning.

There has been much controversy over whether schizophrenia and bi-polar are different natural kinds or whether there isn't really a great deal of difference between them. The diagnosis of schizoaffective was invented to capture those cases that seemed to fall in the middle. One might be inclined (as Bentall does, for example) to regard there to be a continuum where some people exhibit more of the 'traditionally schizophrenic' symptoms while others exhibit more of the 'traditionally mood' symptoms. Basically... Different people will have their different symptoms.

I was reading something the other day about 3 views of medication. One view is that medication is general. Benzo's were used like that, I think, to basically sedate all the patients (regardless of what their diagnosis or symptoms were). Another view is that medication is symptom specific. So it doesn't matter what your dx is if you have delusions (caused by drugs, endocrine disorder, acquired cerebral injury, in the context of depression, in the context of bi-polar, in the context of a psychotic disorder) then anti-psychotics will help. Another view is that medication is diagnosis specific. I think it was... social anxiety without panic (or something along those lines) that only became acknowledged as a kind of mental disorder by virtue of their having developed a treatment that seemed very affective with a subclass of people with panic disorders. Basically... We don't have very many medications like this. Lithium (when effective) might be one of them (for bi-polar), however. But there are plenty of people with a dx of bi-polar who don't respond well to lithium.

> The diagnosis of schizoaffective disorder requires that the patient experience some decline in social functioning for at least a six-month period

> Negative symptoms are the opposite of positive symptoms. They are the absence of thoughts, perceptions, or behaviors that are ordinarily present in people in the general population. These symptoms are often stable throughout much of the patient's life.

Blunted Affect. The expressiveness of the patient's face, voice tone, and gestures is diminished or restricted. However, this does not mean that the person is not reacting to his or her environment or having feelings.

The disorder is usually life-long

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Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms , but as many as one-third of people have some residual symptoms.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated

Apathy. The patient does not feel motivated to pursue goals and activities. The patient may feel lethargic or sleepy, and have trouble following through on even simple plans. Patients with apathy often have little sense of purpose in their lives and have few interests.

Anhedonia. The patient experiences little or no pleasure from activities that he or she used to enjoy or that others enjoy. For example, the person may not enjoy watching a sunset, going to the movies, or a close relationship with another person.

Poverty of Speech or Content of Speech. The patient says very little, or when he or she talks, it does not amount to much. Sometimes conversing with the patient can be unrewarding.

Inattention. The patient has difficulty attending and is easily distracted. This can interfere with activities such as work, interacting with others, and personal care skills.

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So... Bi-polar gives you a better prognosis than schizoaffective.

I would say your doc is doing the right thing in not wanting to dx you with schizoaffective until it really does look like you aren't going to be living a very productive life. A dx of schizoaffective is fairly much 'chronic' by definition, you see.

It makes no difference to your treatment.

It is mostly... A difference in prognosis.