Schizoaffective Disorder: Modern Approaches to Diagnosis and therapy
Schizoaffective disorder (SZa) is the subject of scientific discussion in psychiatry, and approaches to its diagnosis and therapy are rapidly changing according to the development of medical science and practice. the article provides a review of the literature on modern approaches to SZa management. the hypothesis of an extended continuum of schizophrenia (SCh) and bipolar disorder (BaR) suggests three "nuclei": psychotic, cognitive, and affective, which determine the clinical picture of the disease depending on the subtype and stage. the SZa classification continues to improve. In the ICD-10, SZa is defined as a mechanical combination of affective and schizophrenic symptoms as part of an "episodic disorder," it does not reflect the clinical essence of the disease. In DSM-5, the reliability of the SZa diagnosis is improved, more specific criteria are described, and the concept of SZa is changed from episodic to continual disorder. today the most extensive is the SZa classification in the ICD-11. In the diagnostic plan, the SZa is closer to the SCh than to the BaR. Clinical guidelines for the treatment of the SCh spectrum disorders include recommendations for the SZa treatment. the primary treatment goals of SCh and SZa are cognitive remission, recovery, and the patient's functioning restoration. at the same time, the reduction of aggressive and self-damaging behavior, positive and negative symptoms, therapy side effects, and relapse prevention are among the necessary but intermediate treatment results. It`s considered that the complex optimal SZa treatment the combination of psychopharmacotherapy and psychotherapy, both low-intensity and high-intensity. Psychosocial methods are an essential component of therapy, contributing to the improvement of the overall functioning. It is advisable to use psycho-education, compliance therapy, supportive psychotherapy, and cognitive-behavioral therapy. atypical antipsychotics are the first-line therapy for SZa. they provide a significant reduction in psychopathological symptoms and functional remission. Improving the effectiveness of SZa therapy is achieved by combining atypical antipsychotics with mood stabilizers and antidepressants. however, the evidence is still insufficient. therefore, clinical guidelines still lack clear recommendations for practitioners on their prescriptions. Keywords: schizoaffective disorder, schizophrenia, bipolar affective disorder, diagnosis, therapy, antipsychotics.