Hi Dr. Phelps - 

I am married to a man who has carried the diagnosis of Schizoaffective Disorder for 15 years. He is currently in the hospital after having a severe increase in psychotic symptoms, i.e., auditory, visual and tactile hallucinations, and suicidal ideation.

A wonderful psychiatrist, Dr. ...., has taken away the diagnosis of Schizophrenia and has diagnosed him with Bipolar Disorder, Mixed, with Psychotic features. I am wondering if this is common, to diagnose someone with Schizoaffective Disorder only to find out years later that the true diagnosis is Bipolar Disorder, Mixed, with Psychotic Features. She has started him on a mood stabilizer and is taking him down off his neuroleptic medications (namely Seroquel first, next will be the Zyprexa). He is now taking Abilify 20 mg per day, Lamictal, Tegretol, Zyprexa (10 mg now rather than 20), clonazepam, and Lexapro and also clonidine. For the first time since I have known him (4 years) he has a quiet head. No voices AT ALL!!!! I am so jazzed about this, it is a true miracle.

I realize that it is probably very hard to diagnose mental illness but are people being diagnosed with Schizoaffective Disorder when they are really Bipolar? What is the prognosis for the new diagnosis? Do I assume that the voices that go from a low murmur all the way to screaming, will not come back now that he is on the right medication regimen? What should I look for?

I hope this was not too long. Thank you for taking the time to read it and if you have time, an answer would be great. Thanks again. 

 

Dear Ms. N' --
I've edited your question to remove some potential identifying information, but as you can see, the question, which I think is common enough to warrant a general answer, remains:  how often is bipolar disorder called "schizoaffective"? What difference does the label make?

Here are my views on this:  first, schizoaffective is regarded by many experts as an intermediate form on a continuum from bipolar to schizophrenia:

bipolar.......schizoaffective, bipolar type.......schizoaffective, schizophrenic type......schizophrenia

where there are people at all points along the way between the two ends of this spectrum. Therefore, fussing over whether it should be called bipolar, or called schizoaffective, bipolar type, often means very little as far as prognosis or treatment.  In your husband's case, the big change, as I see it, is what the psychiatrist did with the antidepressant, namely taking it out. That would be a smart move to try for any condition with bipolarity in it, if things are not going well. (Don't anybody think about doing that on their own though; it must be done with your doctor's input, especially regarding how slowly to taper it off, not to mention a plan for how to handle things going wrong in the process).

With that change, a lowering of the other medications might be possible, as the doctor has done here.  As for the future, I'd be cautious and keep your hopes in check.  On the other hand, if he's been on an antidepressant for years, as I often encounter, then this shift is a major one and does open the possibility of things going differently now.  However, be cautious. Let the future come to you.  Good luck with all that. Thanks for all the help in the past...

Dr. P'
 

June, 2005