This is the fifth and (for the time being) final piece in our series on schizoaffective disorder. Basically, we are looking at an illness that appears to be a milder form of schizophrenia, with mood swings thrown in for good measure. A lot of the discussion focused on how psychotic and mood episodes related (or not) to each other. What tends to get left out is - never mind the psychosis - schizophrenia is essentially a disorder representing a breakdown in the brain’s capacity to think.
To a lesser extent, we with bipolar also have issues with thinking, even when episode-free. A lot of this may have to do with stress or messed-up sleep interfering with our brain’s ability to process information. The "cure" is relatively simple: find ways of reducing stress in your life and improve your sleep hygiene - voila - life with a clear head. This certainly works for me.
When my brain is not booting up right is when I call in sick. (I am self-employed, so I am lucky in this regard.)
Yes, we may have to cope with residual cognitive difficulties, but these are small potatoes compared to schizophrenia. Also, our capacity to process information nonlinearly - at blindingly fast speeds, in creative ways - may more than offset any minor mental clumsiness we may have.
This is generally not the case with schizophrenia. The cognitive challenges run deep, and are extremely disabling, with few, if any, compensations. Schizoaffective tends to share some of these same traits. Indeed, clinicians may first issue a diagnosis of schizophrenia before "downgrading" to schizoaffective.
So far then - two core domains to schizophrenia: Psychosis and cognitive dysfunction. These also feature in schizoaffective disorder, and to a certain degree in bipolar. Think of bipolar and schizophrenia at opposite ends of the same spectrum, with schizoaffective in the middle, with various symptoms overlapping to a certain extent.
There is also a third core domain to schizophrenia (and by extension schizoaffective) called flat affect, a virtual lack of expression. Poker players would give their right arm for this trait. These symptoms seem tied to lack of emotion (the DSM refers to "avolition").
Bipolars, on the other hand, tend to experience the very opposite, namely exaggerated affect. Yes, flat affect does occur in bipolar, but we tend to exhibit these symptoms only in profoundly vegetative depressions.
Why don’t we wrap up this series with a simple acid test? Contemplate members of a DBSA group going out for coffee after a support group meeting. You have probably been in this situation. You and your group blend right in. The serving staff cannot distinguish you from the diners at the other tables. Now contemplate a different group of individuals waking into the same place. Contemplate the waitress taking their orders.
Two extremes. Somewhere in the middle lurks schizoaffective. Ah, so hard to say.
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