Q: Schizoaffective and/or Bipolar Labels|
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
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
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...