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Do We Need Schizoaffective Disorder?

Posted on 14 Dec 2009
Stephan Heckers Rajiv Tandon

SRF Live Discussion Series: Anticipating the DSM-V
Schizophrenia Research Forum is presenting a series of live discussions focusing on areas of contention within the evolution of the Diagnostic and Statistical Manual (DSM) psychotic disorders area.

The first discussion on 22 July 2009, Is the Risk Syndrome for Psychosis Risky Business?, focused on the proposal to create a diagnostic category for people possibly in the prodrome for schizophrenia.

The discussion on 15 December 2009 was led by Stephan Heckers of Vanderbilt University and Rajiv Tandon of the University of Florida, and addressed the value of the schizoaffective diagnosis. Please read the backgrounder below and the article by Heckers mentioned therein. Then add your comments.

Suggested Reading: Heckers S. Is schizoaffective disorder a useful diagnosis? Curr Psychiatry Rep. 2009 Aug ;11(4):332-7. Abstract

Our apologies; due to copyright issues, we will not be able to provide access to Stephan Heckers's article, "Is schizoaffective disorder a useful diagnosis?"

See Draft of proposed DSM-V modifications.

Click on the images below to launch the slidecasts.

 

Background Text
Hakon Heimer

Emil Kraepelin divided the psychoses into non-affective (dementia praecox, later schizophrenia) and affective (manic depression, later bipolar disorder) types. This dichotomy continues to this day in diagnostic manuals (see SRF related Live Discussion). As discussed by Stephan Heckers in the background text below, Jacob Kasanin introduced the diagnosis schizoaffective disorder in 1933 (Kasanin, 1933) to describe patients with both prominent psychotic and affective symptoms. The diagnosis, with minor variations, has been part of the DSM since its first edition in 1952.

"However, the current DSM-IV-TR diagnosis of schizoaffective disorder is not reliable and is of limited clinical utility," Heckers writes. He traces the evolution of the current schizoaffective disorder diagnosis in the DSM and reviews options for revision (see list of options below, courtesy of S. Heckers). Some modifications are minor, whereas others are more radical. Do we have enough evidence to remove the diagnosis from the DSM? What does a revision of the diagnosis schizoaffective disorder mean for the more fundamental dichotomy of affective and non-affective psychoses? We invite your preliminary commentary on the options presented.

References:
Kasanin J. The acute schizoaffective psychoses. Am J Psychiatry 1933, 90:97"126.

Heckers S. Is schizoaffective disorder a useful diagnosis? Curr Psychiatry Rep. 2009 Aug ;11(4):332-7. Abstract