Schizoaffective or bipolar
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Schizoaffective or bipolar -- effect on treatment

Q: After an initial diagnosis of schizophrenia my dx is now one of schizoaffective/possible manic depression. I have taken lithium by itself for the vast majority of the last 17 years having previously been on anti psychotics. I was always lead to believe that schizoaffective was a diagnosis given to individuals with both bipolar and schizophrenia symptoms. If this is true wouldn't a person with such a diagnosis need to be on an anti psychotic on a more than very occasional basis to help control the 'schizophrenic' side of their illness and if the person was truly schizoaffective would a failure to augment mood stabiliser medication with anti psychotic significantly compromise lessen that person's level of mental health?

Dear Ms. or Mr. L' --
You ask an important and sophisticated question.  The "bottom line" is defined by what works for you, rather than by the theoretical considerations you pursue here.  However, you interpretations are quite theoretically correct.  The problem is, we don't really have a good way of telling whether a person "is schizoaffective" or if she "is bipolar".  In fact, in some respects the choice is made the other way around, as you seem to recognize: if a person requires an antipsychotic to do well, and on mood stabilizers alone they just have too much remaining "psychotic-like" symptoms -- then we tend to call that person "schizoaffective".  By contrast, someone who may have taken antipsychotics for years, who then gets on a mood stabilizer(s) and seems to do well, even when their antipsychotics are (cautiously and slowly) tapered off -- we tend to call that person "bipolar".

So, when we define a person's diagnosis, practically speaking, in large part on the basis of how they respond to certain treatment approaches, it is pretty circular logic.  However, this is not total bunk, mind you: there are good studies to show that people with "schizoaffective (SA) disorder", by the standard diagnostic criteria (DSM), have others in their family with SA; whereas people with "bipolar disorder" have people in their family with BP -- not SA.  So there is some genetic logic to this distinction.

Back to the bottom line: you have to decide what works best for you.  If you can do well without antipsychotics on a regular basis, there is no good evidence to suggest that is harmful for you.  Just beware of relapse and have an excellent "safety net" in case symptoms show up that you wouldn't recognize as such (good advice for anybody with either BP or SA!) and work closely with your treatment providers to make these decisions.

Dr. Phelps

Published November, 2000

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