Is schizoaffective disorder a distinct categorical diagnosis? A critical review of the literature

Figures & data

Table 1 Neuropsychological studies of persons with schizoaffective disorder

Reference	Population	Measures	Findings
Bryson et al 1997	SCZ = 55 SAD = 8	WCST, WAIS-R, Hopkins Verbal Learning, Gorham’s Proverbs, CPT	Greater severity of mood symptoms was associated with perseverative errors, fewer complete categories on WCST and a greater number of errors on CPT.
Woodward et al 2004	SCZ = 62 SAD = 6	RAVLT, BVMT, SSPI	In a combined group of SAD and SCZ patients, an association was found between psychomotor poverty and deficit of episodic memory.
Glahn et al 2006	SCZ = 15 SAD = 15 BMD = 26 Controls = 32	WAIS, DRT	Patients with BMD, SCZ and SAD had deficits on backward digit span. Patients with a lifetime history of psychosis had impairment in spatial delayed response task.
Gooding et al 2002	SCZ = 24 SAD = 12 Controls = 29	Nonverbal working memory	SCZ and SAD patients performed poorly on working memory tasks that are based on the identity and/or features of the stimulus (ie, object-based working memory tasks) as well as on a working memory task based on the spatial location of the stimulus.
Gooding et al 2002	SCZ = 34 SAD = 23 Controls = 30	Spatial working memory and WCST	Both SAD and SCZ had deficits which differed from controls but not each other.
Nangle et al 2006	SCZ = 50 SAD = 18	WAIS, CPT, WTAR, WMS	1/3 of patients were classified as suicide attempters and 2/3 as nonattempters in an Irish Population. SCZ and SAD patients who are attempters outperformed nonattempters in attention and verbal fluency.
Goldstein et al 2005	SCZ = 63 SAD = 20 Controls = 21	WAIS and Trails	Cognitive function of SAD and paranoid subset of SCZ subjects were more cognitively intact than subjects with undifferentiated and residual types of SCZ.
Manschreck et al 1997	SCZ = 19 SAD = 19 MDD = 19 Controls = 19	Verbal recall with alteration of context	SCZ subjects attain smaller gains in recall when context is increased compared to depressed and normal controls. SCZ and SAD subjects, however, did not differ in recall gain on this task.
Roofeh et al 2006	SCZ = 37 SAD = 20 Controls = 60	CVLT	SAD and SCZ did not differ. Schizophrenic spectrum was worse than age and gender matched controls on measures of apprehension, verbal learning, short-term memory, long-term memory and organizational strategies.
Brenner et al 2003	SCZ = 31 SAD = 11	Visual discrimination and recognition, and tests of abstraction, verbal learning, visual memory, working memory and attention WCST, CVLT, CPT, and Family Pictures	Seven subjects with SCZ or SAD were impaired on Family Pictures first recall. Eight were impaired on Letter Number Sequencing. WCST performance was impaired in 12 subjects. CVLT performance was impaired in 28 subjects. CPT performance was impaired in nine subjects.
Bryson et al 2002	SAD = 14 SCZ = 28	WCST, WAIS	SCZ and SAD patients were below normal at initial assessment. Reassessment 3 years later did not show a decrease in function, and 20% showed some improvement.
Mitrushina et al 1996	SCZ = 21 SAD = 18 BMD I = 18 MDD with Psychosis = 25 Psychotic DO NOS = 25	Neurobehavioral Cognitive Status Examination	SAD and SCZ had a deficit on “similarities’ scale suggesting a deficit in abstract reasoning. SAD and SCZ also had a deficit in terms of lowest spontaneous recall.
Oltmanns et al 1985	SCZ = 10 BMD I = 11 SAD = 11 MDD = 10	Ratings of verbal communication impairments	SAD, SCZ and BMD subjects had more derailment than normals and MDDs. SAD, BMD and SCZ all had loss of goal and decreased global rating compared with normals and MDDs.
Pope and Kern 2006	SCZ and SAD = 36 Controls = 22	Word-stem completion task	A measure of learning was applied to this combined population of SCZ and SAD. The combined group had more problems with the task when errors where included in the task.
Stip et al 2005	SAD = 13 SCZ = 44	Motor Screening, reaction time, Paired Associates Learning Task, and Stockings of CANTAB items	SCZ and SAD differed on visuo-motor coordination and visuospatial substests, with SAD subjects performing better than subjects with SCZ.
Kolakowska et al 1985	SCZ = 42 SAD = 14	Neurological ‘soft’ signs, CT scan and cognitive impairment	No relationship between the size of the lateral brain ventricles on CT scan and either ‘soft’ signs or cognitive impairment.

Abbreviations: SAD, schizoaffective disorder; SCZ, schizophrenia; BMD I, type I bipolar mood disorder; MDD, major depressive disorder; CVLT, California Verbal Learning Test; DRT, Spatial Delayed Response Task; WCST, Wisconsin Card Sort Test; CPT, Continuous Performance Task; WAIS, Wechsler Adult Intelligence Test; WMS, Wechsler Memory Scale; WTAR, Wechsler Test of Adult Reading; RAVLT, Rey Auditory Verbal Learning Test; BVMT, Brief Visual Memory Test; SSPI, Signs and Symptoms of Psychotic Illness; CT, computed tomography of the brain.

Table 2 Neuroimaging findings among studies of persons with schizoaffective disorder

Reference	Population	Method	Findings
Jurjus et al 1993	SCZ = 67 BMD and SAD = 60 Controls = 37	cMRI	A higher frequency of cavum septum pellucidum was observed among subjects with SCZ than among BMD and SAD subjects. No clinical difference was found between SCZ with or without cavum septum pellucidum.
Prasad et al 2004	SCZ and SAD = 33 Non-SCZ psychotic disorders =11 Controls = 43	vMRI	Left parahippocampal gyrus (PHG) was significantly smaller in subjects with SCZ compared to non-SCZ psychotics but not controls. In psychotic subjects, PHG volume negatively correlated with total positive symptom, delusion and conceptual disorganization scores. Patients with delusions had relatively smaller PHG compared to nondelusional subjects.
Buchanan et al 2004	SCZ and SAD = 44 Controls = 34	vMRI	Patients had smaller inferior prefrontal region volumes and reversal of the normal asymmetry of the inferior parietal cortex. No significant group differences were found in superior temporal gyrus volume.
Van Erp et al 2004	Probands with SAD = 12 SCZ = 60 Proband siblings = 58 Controls = 53	vMRI	Decrease hippocampal volumes in probands compared to siblings. Decrease volumes of siblings compared to normal controls. SAD probands have diminshed hippocampal volumes with fetal hypoxia. Decreased hippocampal volumes correlate positively with age at onset for the combined SCZ and SAD group.
Canon et al 2002	SCZ and SAD = 64 1st degree relatives = 51 Controls = 54	vMRI	Fetal hypoxia predicted reduced gray matter and increased CSF bilaterally throughout the cortex in patients and siblings, most strongly in the temporal lobe. Hypoxia correlated significantly with ventricular enlargement, but only among subjects with psychosis.
Getz et al 2002	SAD = 12 BMD = 12 Controls = 12	vMRI	SAD and BMD had significantly smaller cerebral volumes than controls. Globus pallidal difference was the largest contribution to this difference.
Bilder et al 1999	Mood DO and SAD = 81 SCZ and SCZF = 87 Controls = 67	vMRI	A composite index of asymmetry across regions (‘torque’), all showed the same diagnostic group effect, with the SCZ group showing least normal asymmetry, the mood DO group intermediate asymmetry, and the control group the most asymmetry.
Cannon et al 1998	SCZ = 62 SAD = 12 Nonpsychotic siblings = 60 Controls = 56	vMRI	Subjects with SCZ and SAD and their siblings exhibited significant reductions in cortical gray matter volume and significant increases in sulcal CSF volume compared with controls. The subjects, but not their siblings, exhibited significant reductions in white matter volume and significant increases in ventricular CSF volume. For subject and sibling groups, gray matter volume reductions and sulcal CSF volume increases were significantly most pronounced in the frontal and temporal lobes.
Szeszko et al 2005	First episode SAD = 5 SCZ = 5 Controls = 13	MRI-DTI	Decrease left internal capsule and left-hemisphere white matter of middle frontal gyrus and posterior superior temporal gyrus.
Ardekani et al 2003	SCZ and SAD = 14 Controls = 14	MRI-DTI	Abnormal white matter in corpus callosum, left superior temporal gyrus, parahippocampal gyri, middle temporal gyri, inferior parietal gyri, medial occipital lobe, and deep frontal perigenual region.
Stone et al 2005	SCZ = 6 SAD = 2 All subjects with memory deficits	fMRI	Greater activation of the left parahippocampus in the glucose condition, compared to the saccharin condition, despite no change in memory performance.
Keshavan et al 2003	SAD = 10 SCZ = 6 Controls = 37	P^31 MRS	Increase in psychotic subjects of freely mobile phosphomonoester which is consistent with white matter changes in this group of patients.

Abbreviations: SAD, schizoaffective disorder; SCZ, schizophrenia; BMD, bipolar mood disorder; Mood DO, mood disorder; SCZF, schizophreniform; cMRI, conventional magnetic resonance imaging; vMRI, volumetric magnetic resonance imaging; MRI-DTI, magnetic resonance imaging with diffusion tensor imaging; fMRI, functional magnetic resonance imaging; P³¹ MRS, phosphorus³¹ magnetic resonance spectroscopy.

Table 3 Electrophyiologic studies of persons with schizoaffective disorder

Reference	Population	Method	Findings
Olincy and Martin 2005	BMD = 42 SAD = 22 Controls = 42	ERPs P50 auditory evoked potential	SAD and BMD with psychosis demonstrated higher P50 ratios (nonsuppression) compared to controls and BMD subjects without a history of psychosis.
Kumar and Debruille 2004	SCZ and SAD	Review of 10 studies of N400 amplitude in these populations	Diminished N400 amplitude in SCZ and SAD.
Brenner et al 2003	SCZ and SAD = 23 Controls = 22	ERPs sensory N100 and EEG synchronization to modulated auditory tones	SCZ and SAD have decreased power in steady-state responses to periodic stimuli, despite normal N100 responses.
Kayser et al 2001	SCZ = 46 SAD = 20 Controls = 32	ERPs tonal and oddball tasks	Patients showed marked, task-independent reductions of early negative potentials. Task-related hemispheric asymmetries were similar in healthy adults and subjects.
Kayser et al 1999	SCZ = 16 SAD = 8 Controls = 19	ERPs of a continuous word recognition memory task	Accuracy of word recognition memory was poorer in subjects than controls, and subjects showed markedly smaller N2 amplitude. Among controls, asymmetry was not present in patients and suggested a left lateralized deficit among subjects.
Bruder et al 1998	SCZ = 19 SAD = 9 Controls = 28	ERPs during a dot enumeration task	Subjects showed poorer dot enumeration than did controls and also had markedly reduced early negative ERPs.
Boutros et al 1997	SAD = 19 SCZ = 50 BMD = 16 Controls = 41	ERPs – P50 N100 oddball, P200 P300	SAD had significant decrease in P200 compared with controls and SCZ (but not BMD) and otherwise did not separate from other groups.
Borenstein et al 1988	SCZ = 27 SAD = 13 Controls = 27	ERPs – CNV (contingent negative variation)	Pre- and post-imperative phases of the CNV were heterogeneous in character suggesting the possibility of multiple disturbances. When present, the pre-imperative negativity was of lower amplitude and had a delayed return to the baseline with a wider dispersion.
Saccuzzo and Braff 1986	SCZ = 11 SAD = 11 BMD = 11 MDD = 11	ERPs – visual masking paradigm assessing response at 500 msec post-stimulus	MDD was different than SAD, BMD and SCZ in some measures of this paradigm.
Inui et al 1998	SCZ = 33 SAD = 12 Mood-incongruent psychotic mood disorder = 12 nonpsychotic mood disorder = 62 SCZF = 12	EEG	Increased epileptiform variants in mood-incongruent psychotic mood disorder (33%), SAD (33%), and SCZF (30%), compared with nonpsychotic mood disorder (3.2%) and SCZ (0%).
Benson et al 1996	SAD = 3 SCZ = 11	EEG and CT measures of ventricular volume	Deficits in slow wave sleep correlated with ventricular volume
Keshaven et al 1995	SCZ = 12 SAD = 8	EEG – slow-wave delta sleep	Decreased percentage of delta sleep significantly correlated with poorer clinical outcomes at 1 and at 2 years.
Benson and Zarcone 1982	SCZ = 11 SAD = 8 MDD = 10 Controls 13	Rate of middle ear muscle activity during REM sleep	Middle ear muscle activity was lowest for SAD, than normal patients, than depressed and highest for SCZ patients.
Teale et al 2000	SCZ = 14 SAD = 12 Controls = 23	MEG – Localization of magnetic sources for auditory M100 signals	SAD and SDZ exhibited different source localization in auditory cortex compared to one another and controls.
Reite et al 1999	SAD = 16 Controls = 16	Magnetoencephalography (MEG) M20 for median nerve stimulation	Reversed asymmetry of M20 in SAD located on the post-central gyrus in this disorder.
Kathmann et al 2003	SCZ and SAD = 54 Affective DO = 43 Relatives: Psychosis = 43 Affective DO = 36 Controls = 84	Eye tracking tasks	Decreased eye pursuit gain in SCZ and affective disorders. This deficit is present, to a lesser extent, in their relatives.
Lieberman 1993	SAD = 16 SCZ = 54	Eye movement tracking	Morphologic abnormalities of the medial temporal lobe and third ventricle were associated with normal eye tracking suggesting changes in SAD and SCZ are part of the disease process not pathologic changes.
Goode and Manning 1985	SAD = 10	EMG – Hoffmann reflex recovery	Right-left differences in Hoffmann reflex (H reflex) recovery curve height significantly correlated with standardized scales of psychopathology.

Abbreviations: SAD, schizoaffective disorder; SCZ, schizophrenia; BMD, bipolar mood disorder; Mood DO, mood disorder; MDD, major depressive disorder; SCZF, schizophreniform; ERP, event-related potential; EEG, electroencephalography; CT, computed tomography; REM, rapid eye movement; MEG, magnetoencephalography; EMG, electromyography.

Table 4 Neuroendocrine studies of persons with schizoaffective disorder

Reference	Population	Method	Findings
Mokrani et al 2000	SAD = 31 SCZ = 16 MDD = 87 Controls = 22	Growth hormone responses to the clonidine challenge	Lower GH response to stimulation with clonidine among MDD and SAD subjects when compared to SCZ subjects and controls.
Kumar and Marks 1993	Post-partum and a history of BMD or SAD SCZ = 46 SAD = 19 MDE = 50 Controls = 18	Growth hormone responses to clonidine and apomorphine challenge	Increased growth hormone response to apomorphine challenge test compared to those who remained well and to controls. Life events history did not influence these findings
Lieberman et al 1993	SAD = 16 SCZ = 54 Controls = 50	GH secretion in response to methyphenidate challenge	Abnormal GH secretion and decreased GH response to methylphenidate in the subjects with psychosis.

Abbreviations: SAD, schizoaffective disorder; SCZ, schizophrenia; BMD, bipolar mood disorder; MDD, major depressive disorder; MDE, major depressive episode; GH, growth hormone.

Table 5 Neurochemical studies of persons with schizoaffective disorder

Reference	Population	Method	Findings
Faustman 1999	Medication-free males with: SCZ = 13 SAD = 6	CSF glutamate	Ratings of positive symptoms were inversely correlated with CSF glutamate concentrations. Hallucinatory behavior was strongly correlated with CSF glutamate concentrations. In a subset of subjects who received haloperidol, haloperidol did not alter CSF glutamate concentrations and symptoms no longer correlated with CSF glutamate levels.
Sharma et al 1998	Inpatients with: SCZ = 33 SAD = 21	Plasma HVA	Correlation between length of inpatient stay and plasma HVA levels.
Sharma et al 1993	Inpatients with: SCZ = 15 SAD = 4	CSF – HVA	Plasma homovanillic acid levels correlated with length of inpatient treatment but not other measures or group differences.
Sharma et al 1997	Inpatients with: SCZ = 29 SAD = 13	CSF neurotensin	Neurotensin levels were decreased pre-treatment in both SAD and SCZ subjects. Lower neurotensin levels pre-treatment were associated with increased severity of psychopathology. Neurotensin levels increased with treatment.
Sharma et al 1995	SAD, SCZ, BMD (either manic or depressed) = 16	CSF phenylacetic acid	No difference in CSF phenylacetic acid levels as a function of psychiatric diagnosis.
Sharma et al 1994	Inpatients with: SAD = 3 SCZ = 14	CSF somatostatin	Duration of treatment correlated with CSF somatostatin levels, but there were no differences between subject groups.
Laruelle et al 1993	SCZ = 12 SAD = 9 Nonpsychotic suicide victims = 9 Controls = 16	Post-mortem serotonin receptors	Serotonin uptake sites were decreased in prefrontal cortex of psychotic subjects who died of natural causes, but not among psychotics who died from suicide, controls, and nonpsychotic suicide victims.

Abbreviations: SAD, schizoaffective disorder; SCZ, schizophrenia; BMD, bipolar mood disorder; HVA, homovanillic acid; 5-HT, serotonin; PGE1, prostaglandin E₁ stimulated adenylate cyclase activity; NE, norepinephrine; GABA, gamma-aminobutyric acid.

Table 6 Genetic studies of persons with schizoaffective disorder

Reference	Population	Genetic linkage	Ethnicity/Geography
Hamshere et al 2005	SAD = 35	Suggestive linkage on chromosomes 1q42, 22q11,19p13.	United Kingdom
Liu et al 2005	SCZ and SAD = 52	Suggestive linkage of neuregulin 1 (NRG1) on chromosome 8p21 (NRG1 is an isoform of glial growth factor 2).	Taiwanese family
Staddon et al 2005	SCZ = 105 SAD = 13 Controls = 162	Increase in dopamine D3 receptor gene alleles-7685-C, SeaGly and 205 G/A.	Basque family
Giouzeli et al 2004	SCZ and SAD = 294 Families containing 2 members with these diagnoses	Neither the coding variants nor the intron polymorphisms of protocadherin X/Y are related to psychosis within families.	United Kingdom
Hodgkinson et al 2004	SAD = 62 SCZ = 196 BMD = 82 Controls = 17	SAD has decrease of the common haplotype of intron 1/exon 2 of DISC1. In addition, SAD has an increase in exon 9. Multiple haplotypes between exon 1 and 9 are associated with SCZ, SAD and BMD. (DISC1 gene, on chromosome 1q42, was discovered and linked to schizophrenia in a Scottish kindred carrying a translocation).	United States
Kirov et al 2004	Parents of probands with: SCZ = 441 SAD =47	Increase in DTNBP1 markers p1635 and p 1757.	Bulgaria
Skol et al 2003	SCZ =361 SAD = 31	Increase in NOTCH4 at 6p21.3.	United States veterans
Willour et al 2003	BMD I = 134 BMD II = 41 SAD = 5 MDD = 43	Large predominant bipolar pedigree had linkages at 4q35, 4q 32 and 20p12.	United States BMD pedigrees
Dick et al 2003	BMD I = 232 SAD/Bipolar type = 32 BMD II = 72 MDD = 88, recurrent and siblings.	Large predominant bipolar pedigree with linkage greatest at 17q, 6q, and less at 2p, 3q and 8q. The less strong linkages included patients with less severe BMD and MDD.	United States
Segurado et al 2003	BMD = 2300 cases, 617 pedigrees and spectrum SAD/Bipolar = 82	Findings were not significant on 13q or 22q.	Ireland
Wijsman et al 2003	SCZ and SAD = 32	Linkage at 2q37 in a population of reduced heterogeneity.	Micronesia
Faraone et al 2002	Family members of subjects with: SCZ = 360 SAD = 32	Linkage at 13q32.	United States veterans
DeLisi et al 2002	SCZ and SAD = 294 Families containing at least 2 members with these diagnoses	Linkage on chromosome 5q.	Costa Rica
Cardno et al 2001	Sibling pairs with either SCZ or SAD. Total = 94	Six areas of possible relationship of age of onset of schizophrenia to specific 20 cM areas of DNA in 13q	United Kingdom
Ujike et al 2001	SCZ = 188 SAD = 3 Controls = 143	NOTCH4 at 6p21.3 not significant in Japan.	Japan
Weiss et al 1996	SCZ = 91 SAD = 20 MDD/dysthymia = 90	Increase in frequency of D4.7 allele and DRD4 polymorphism in patients with psychosis.	Germany

Abbreviations: SAD, schizoaffective disorder; SCZ, schizophrenia; BMD, bipolar mood disorder; BMD I, type I bipolar mood disorder; BMD II, type II bipolar mood disorder; MDD, major depressive disorder; DNA, deoxyribonucleic acid.

Table 7 Treatment studies of persons with schizoaffective disorder

Reference	Study design	Population	Medication	Finding
Baethge et al 2004	Meta-analysis of 39 trials 36 months in duration, with emphasis on SAD	SAD = 49 lithium = 41 carbamazepine = 8	Lithium, anticonvulsants and antipsychotics	Lithium and carbamazepine are more effective among persons whose predominant symptoms are emotional (and especially bipolar-type) whereas clozapine is more effective among persons whose predominant symptoms are psychotic in character.
Davis and Chen 2004	Meta-analysis of 4 prospective randomized placebo-controlled studies	SCZ and SAD n = not provided	Antipsychotics	Minimal effective dose for olanzapine = 16 mg; risperidone = 4 mg; ziprasidone = 120 mg; aripiprazole = 10 mg; clozapine = 400 mg; haloperidol = 3.3 mg.
Harvey et al 2004	6-week multi-center, randomized, double-blind parallel design	SCZ = 84 SAD = 52	Ziprasidone or olanzapine	Significant increase from baseline in attention, memory, working memory, motor speed, and executive functions without improvement in clinical symptoms as measured by PANSS. Treatment with olanzapine was also associated with a statistically significant improvement in verbal fluency.
Chengappa et al 2003	Randomized, double-blind, prospective	SCZ and SAD n = 21	Once- vs twice-daily quetiapine	70% of the subjects had no differences in response as a function of single dosing. Most subjects maintained efficacy switching to the new dosing schedule but 15% did experience worsening of symptoms or orthostatic hypotension.
Marder et al 2003	Randomized, double blind, placebo-controlled multicenter	SCZ and SAD = 209 SCZ alone = 89	Aripiprazole, risperidone, haloperidol	Aripiprazole, risperidone, and haloperidol were more effective than placebo. All agents were effective as early as 1–2 weeks after treatment initiation. Side effect profiles were most favorable for aripiprazole.
Harvey et al 2003	Multicenter, randomized, double-blind, parallel group comparison, not placebo controlled	Elderly subjects with SCZ and SAD = 388 n = 176	Risperidone olanzapine	Low-dose risperidone and olanzapine improve cognitive function.
Bilder et al 2002	14 week double-blind, randomized, not placebo controlled	SCZ, n = 86 SAD, n = 15	Clozapine, olanzapine, risperidone, and haloperidol	Global neurocognitive function improved the most with olanzapine and risperidone when compared to haloperidol. Patients treated with risperidone had the most improvement in memory when compared to clozapine and haloperidol. Neurocognitive function was assessed using a battery of 15 tests that included domains of general ability, learning and memory, attention, executive functions, and motor skills.
Sajatovic et al 2002	4-month, multicenter, open-label trial among outpatients with psychosis	SAD: Q: n = 158 R: n = 57 BMD: Q: n = 83 R: n = 20 MDD: Q: n = 75 R: n = 26 SCZ: Q: n = 218 R: n = 67	Quetiapine (Q) and risperidone (R)	Quetiapine produced a greater improvement than risperidone in all patients. Extrapyramidal syndrome occurred significantly less frequently among patients taking quetiapine.
Vieta et al 2001	6-week open label study – addition of risperidone to patients mood stabilizing agents	SAD bipolar type n = 102	Risperidone	Risperidone in doses of 4.7 mg daily reduced psychotic and manic symptoms with a low frequency of side effects.
Tohen et al 2001	6 week multicenter, double-blind study	SAD bipolar type n = 177	Olanzapine or haloperidol	Olanzapine was better than haloperidol in reducing symptoms of depression and improving patients’ cognitive symptoms.
Levinson et al 1999	Review 19 controlled studies, using RDC, ICD-9 and DSM II criteria in most studies.	SCZ and SAD n = 535	Antipsychotics, antidepressants, lithium	Antipsychotics are most effective for treatment of psychosis. Antidepressants are effective for treatment of depression. Lithium does not help depression or mania among subjects with a primary diagnosis of SCZ.
McElroy et al 1999	Review of 14 controlled studies which compared treatment outcomes (not blinded, not placebo and not multiple center), which used RDC, DSM-II and Mayer-Gross criteria.	Acute treatment (app. 1 month) of SAD n = 322	Antipsychotics, lithium and antidepressants	Both mood and psychotic symptoms require treatment. Agents specific to each type of symptom are required.
Keck et al 1996	Review of 14 controlled studies which compared treatment outcomes (not blinded, not placebo and not multiple center), which used RDC and DSM-II in most studies.	Acute (app. 1 month) and prophylactic treatment of SAD n = 322	Typical antipsychotics, thymoleptics, or a combination of these agents	Among subjects with SAD bipolar type (manic), typical antipsychotics and lithium were equally effective; however, among agitated patients antipsychotics were more effective than lithium. In a controlled study of the acute treatment of SAD depressive type, combined treatment with antipsychotics and antidepressants was not superior to treatment with antipsychotics alone.

Abbreviations: SAD, schizoaffective disorder; SCZ, schizophrenia; BMD, bipolar mood disorder; MDD, major depressive disorder; PANSS, positive and negative syndrome scale; RDC, research diagnostic criteria

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