[lazlo]

A total of 36% of patients with a diagnosis of schizoaffective disorder at first assessment switch, many to schizophrenia (19%), 14% to affective disorders, and 6% to other disorders.

Among patients diagnosed with schizoaffective disorder at second assessment, 55% had received a different diagnosis at first assessment, a large portion of whom had been initially diagnosed with affective disorder (24%), schizophrenia (18%), and other disorders (12%).

Diagnostic shift in patients diagnosed with schizoaffective disorder: a systematic review and meta-analysis of rediagnosis studies - Santelmann - 2016 - Bipolar Disorders - Wiley Online Library

that's like 40 or 50 percent of people being diagnosed with something different before or after schizoaffective. why so many changes?

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[OliverB]

I guess because some people have affective disturbances before showing the psychotic side of the illness, while others have first the psychotic disturbances and the disturbed affective episodes apear later.

For example, I have had psychosis since 11, but I never had an hypomanic, manic or depressive episode until 13.

I am not diagnosed with schizoaffective but I have psychosis, affective disturbances and suffer from dissociation, so I am a bit schizoaffective-like. Right now my diagnosis is Psychosis NOS, I am still being evaluated.

about being diagnosed firts with schizoaffective and later with bipolar or depression, It could be because the bipolar or depression was with a lot of psychotic symptoms, but they later saw psychosis only happened only during an episode.

and being changed to schizophrenia after being diagnosed with schizoffective could be because some people wtih schizophrenia suffer from affective disturbances that are not severe or clear enough to be affective episodes, but they could look like one, also, there is post-psychotic depression after a psychotic episode in schizophrenic people that's not the same than schizoaffective depressive subtype. Some people with deorganized symptoms may look hypomanic if they laugh, talk fast and incoherently or look happy in every situation while it's not an affective disturbance but an emotional deorganization.

[still_crazy]

Psychiatry isn't exactly the most scientific branch of medicine. I'm currently diagnosed Bipolar I, but I've also been diagnosed with Schizophrenia and a severe mood disorder, at the same time.

Diagnosis matters for billing and for guiding treatment. That's about it. I prefer the Bipolar I diagnosis because my current treatment works well for me, and Bipolar I is a less stigmatizing diagnosis than Schizophrenia or Schizoaffective.

There's a lot that goes into psychiatric diagnosis besides symptoms. There's some research that shows that minorities and poor people get diagnosed w/ psychotic disorders more often than white people and more affluent people, even when they present with similar symptoms.

Personally, I've found that the doctors who diagnosed me with "Schizophrenia" had a serious problem with me and looked down on me. The diagnosis was about labeling and control. My current doctor sees hope for me. Plus, my people take care of me now, and they're considered "genteel," where before they were more middle-class. See what I mean? Social class and social status affects diagnosis and treatment. If I were poor, I'd be on involuntary Haldol shots, no doubt.

[Kuras]

My diagnosis switched to SZA once my hallucinations, delusions, etc had clearly demonstrated to persist whether in a mood-state of not. The diagnosis is a difficult one to pin down to say the least. It's why a good psych will withhold judgement until sufficient evidence has shown.

[ninjasm]

With military mental health clinics I have been on a wheel-of-diagnosis... it seems like every few months they spin it again. Right now I am in an unusual place of being in a diagnosis that seems to stick: schizoaffective depressive-type. But I've been diagnosed in the past with schizotypal PD (which was a military career friendly way of labeling me I think), Major depressive, persistent depressive, bipolar I, bipolar II, cyclothemic, OCD, PTSD, avoidant PD. Right now it's schizoaffective, OCD, PTSD and they are in the process of retiring me for it.

[lazlo]

The thing about schizoaffective is that no one seems to have heard of it.
so you can make up things like its a headache or something

[ninjasm]

I just say schizophrenic. Then the assumptions start.

[Kuras]

I tend to simply say schizophrenic as well if the person is not versed in mental illness. By this time, however, I'm beyond caring about the assumptions.

[still_crazy]

diagnosis is really mostly for billing and guiding treatment. My diagnosis is Bipolar I w/a psychotic component, but a lot of doctors would call it Schizoaffective, maybe Schizophrenia with a mood disorder.

The big issue is getting effective and appropriate treatment and avoiding ineffective and possibly harmful ones. For instance, some people with the Bipolar I diagnosis are given stimulants. Most people with Schizophrenia or Schizoaffective labels are not prescribed stimulants, because stimulants can be damaging to those with a heavy psychotic component to their problems.

[Fuzzybear]

"Labelling and control"
(I agree)

[lazlo]

many scientists are working right now
to find biomarkers that identify psychosis
like blood tests and such

I hope they can find real diagnostic material using brain scans and other aspects other than just behavior. That could make huge strides in effective treatment.

[still_crazy]

Diagnosis isn't all that important. I'm diagnosed as Bipolar I, so I take 1 atypical, 2 anti-seizure drugs, and wellbutrin. If I was diagnosed Schizoaffective or Schizophrenia with mood issues, the drugs would hopefully be more or less the same, although I don't think they use Wellbutrin in people labeled with Schizophrenia very often.

From what little I've read on it, the big deal with Schizoaffective is prognosis. The long term outlook for the manic form is better than Schizophrenia, not quite as good as Bipolar I. I think the depressive form is closer to Schizophrenia in terms of prognosis.

Of course, there's a lot of heterogeneity within the Schizophrenia diagnosis. that's one thing I can't stand about the label Schizophrenia. Its more like an invalidation, a condemnation, than a diagnosis. You can be Schizophrenic if you're too sad, too happy, talk too much, talk too little, are too active, not active enough, etc. They really need to start breaking Schizophrenia up into different diagnoses. In Japan, they got rid of Schizophrenia as a diagnosis, because it was so stigmatizing.

[avlady]

I still don't know my diagnosis as if it is schitzoaffective or phrenia. every time i have an episode and end up in the ward it gets changed because they need to see my actions and change the dose and kind of med i'm on. well hopefully the clozapine will continue to work, it has been for over 2 years now.

[still_crazy]

I talked to my counselor about this today. My current diagnosis is Bipolar I with a psychotic component. so, I asked him "how is that different from schizophrenia or schizoaffective?," and he basically said that, for me, it was really about the doctor's interpretation of symptoms and the drugs they thought would work.

The problem I have with treatment for Schizophrenia is that they often use high(er) doses of antipsychotics and ignore mood and anxiety problems. Higher doses of antipsychotics don't fix everything, obviously. That's one reason why I'm glad my problems are considered "Bipolar I," because the prescribed drugs work better than just an antipsychotic or just a mood stabilizer ever did.

avlady...I hope the clozapine continues to work, too. I know someone else on it, with lamictal, and she's doing well several years into treatment.

[neodoering]

I was diagnosed schizoaffective right at the first visit to the intake clinician, and I've always felt it was a good label. One psychiatrist I dealt with thought I might have straight-up schizophrenia, but he didn't push it, and the AP drugs used to treat the two conditions are the same.