Diagnosis and differential diagnosis

The DSM-IV diagnosis of schizoaffective disorder(20) is listed in the category of 'schizophrenia and other psychotic disorders'. The major feature of the disorder is that, in addition to meeting the clinical criteria for schizophrenia (criterion A), an individual must also experience a major depressive, manic, or mixed episode concurrently. In addition, in the same period of illness, a patient must experience symptoms of psychosis (hallucinations and/or delusions) for a period of at least 2 weeks, in the absence of mood-related symptoms (criterion B). Nevertheless, affective symptoms must comprise a substantial portion of total duration of the illness (criterion C), and symptoms may not be attributable to either substance use or to a major medical condition (criterion D). Two subtypes of the disorder, including bipolar type and depressive type, may be diagnosed.

The criteria for schizoaffective disorder in ICD-10 are similar to those in DSM-IV. The essential requirement is that prominent symptoms of affective disorder and prominent symptoms of schizophrenia are present together for at 2 weeks. Depressive, manic, and mixed subtypes are recognized as in DSM-IV.

The differential diagnosis includes, most prominently, either schizophrenia or affective disorder, which may be differentiated in part by consideration of the longitudinal criteria (criteria B and C), in addition to the cross-sectional criteria (criterion A). The presence of conditions relating to general medication and substance use should also be considered in the differential diagnosis.

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