Download PDF
Pharmacopsychiatry 2003; 36(2): 45-56
DOI: 10.1055/s-2003-39045
Review
© Georg Thieme Verlag Stuttgart · New York

Long-term Treatment of Schizoaffective Disorder: Review and Recommendations

C. Baethge1
  • 1Dept. of Psychiatry and Psychotherapy, Freie Universität Berlin, Berlin, Germany
Further Information

Publication History

Received: 28.12.2001 Revised: 10.5.2002

Accepted: 17.6.2002

Publication Date:
06 May 2003 (online)

Also available at
    Permissions and Reprints

Objective: To provide an overview of long-term treatment studies in schizoaffective disorder (SAD) and to draw conclusions for clinical decision-making. Method: Literature was identified by searches in Medline, Embase, and the Cochrane Controlled Trials Register as well as a hand-search of handbook and journal articles. Studies were considered relevant if they reported on trials of at least 6 months duration and if they presented data for the SAD patients in particular. Results: Thirty-nine studies met the criteria and 18 used modern diagnostic criteria, i. e., RDC, DSM-III-R, -IV, or ICD-10. The studies focused on lithium, anticonvulsants, and antipsychotics. The scientific evidence for prophylactic efficacy of the different substances is poor. Nevertheless, the data encourage the use of lithium and carbamazepine in primarily affective patients and clozapine in primarily schizophrenic patients and possibly in mainly affective patients as well. Conclusions: There is a considerable need for prospective and controlled studies on the long-term treatment of SAD. However, it seems to be useful to subtype the disorder of the patients into primarily affective vs. schizophrenic schizoaffective disorder and schizodepressive vs. schizobipolar and to treat accordingly.

Key words

schizoaffective disorder - long-term treatment - prophylaxis - maintenance therapy - review

References

  • 1 American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd edn. revised (DSM-III-R). Washington, DC; APA 1987
    Google Scholar
  • 2 American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edn. (DSM-IV). Washington, DC; APA 1994
    Google Scholar
  • 3 Angst J, Preisig M. Course of a clinical cohort of unipolar, bipolar and schizoaffective patients. Results of a prospective study from 1959 to 1985.  Schweiz Arch für Neurol und Psychiat. 1995;  146 5-16
    PubMedGoogle Scholar
  • 4 Angst J, Preisig M. Outcome of a clinical cohort of unipolar, bipolar and schizoaffective patients. Results of a prospective study from 1959 to 1985.  Schweiz Arch für Neurol und Psychiat. 1995;  146 17-23
    PubMedGoogle Scholar
  • 5 Angst J, Weis P, Grof P, Baastrup C, Schou M. Lithium prophylaxis in recurrent affective disorders.  Br J Psychiatry. 1970;  116 604-613
    PubMedGoogle Scholar
  • 6 Angst J, Dittrich A, Grof P. Course of endogenous affective psychoses and its modification by prophylactic administration of imipramine and lithium.  Int Pharmacopsychiat. 1969;  2 1-11
    PubMedGoogle Scholar
  • 7 Aronoff M S, Epstein R S. Factors associated with poor response to lithium carbonate: A clinical study.  Am J Psychiatry. 1970;  127 472-480
    PubMedGoogle Scholar
  • 8 Baastrup P C, Schou M. Lithium as a prophylactic agent.  Arch Gen Psychiatry. 1967;  16 162-172
    PubMedGoogle Scholar
  • 9 Baethge C, Gruschka P, Berghöfer A, Bauer M, Müller-Oerlinghausen B, Bschor T, Smolka M N. Prophylaxis of schizoaffective disorder with lithium or carbamazepine: outcome after long-term follow-up. J Affect Disord 2002, in press
    Google Scholar
  • 10 Banov M D, Zarate C A, Tohen M, Scialabba D, Wines J D, Kolbrener M, Kim J W, Cole J O. Clozapine therapy in refractory affective disorders: polarity predicts response in long-term follow-up.  J Clin Psychiatry. 1994;  55 295-300
    PubMedGoogle Scholar
  • 11 Bellaire W, Demisch K, Stoll K D. Carbamazepin vs. lithium.  Münch Med Wschr. 1990;  132 (Suppl 1) S82-86
    PubMedGoogle Scholar
  • 12 Bocchetta A, Chilotti C, Severino G, Ardau R, del Zompo L. Carbamazepine Augmentation in lithium-refractory bipolar patients: a prospective study on long-term prophylactic effectiveness.  J Clin Psychopharmacol. 1997;  17 92-96
    CrossrefPubMedGoogle Scholar
  • 13 Bogan A M, Brown E S, Suppes T. Efficacy of divalproex therapy for schizoaffective disorder.  J Clin Psychopharmacol. 2000;  20 520-522
    CrossrefPubMedGoogle Scholar
  • 14 Bouman T K, Niemantsverdriet-van Kampen J K, Ormel J, Sloof C J. The Effectiveness of lithium prophylaxis in bipolar and unipolar depressions and schizo-affective disorders.  J Affect Disord. 1986;  11 275-280
    CrossrefPubMedGoogle Scholar
  • 15 Cabras P L, Hardoy J, Hardoy M C, Carta M G. Clinical experience with gabapentin in patients with bipolar and schizoaffective disorder: Results of an open-label study.  J Clin Psychiatry. 1999;  60 245-248
    PubMedGoogle Scholar
  • 16 Cochrane C ollaboration. The Cochrane Controlled Trials Register. The Cochrane Collaboration 2001 Issue 4
    Google Scholar
  • 17 Ciapparelli A, Dell’Osso L, Pini S, Chiavacci M C, Fenzi M, Cassano G B. Clozapine for treatment-refractory schizophrenia, schizoaffective disorder, and psychotic bipolar disorder: A 24-months naturalistic study.  J Clin Psychiatry. 2000;  61 329-334
    PubMedGoogle Scholar
  • 18 DelBello M P, Lopez-Larson M P, Getz G E, Strakowski S M. Treatment of schizoaffective disorder with divalproex sodium (letter).  Schizoph Res. 2000;  46 77-7
    PubMedGoogle Scholar
  • 19 Delva N J, Letemendia F JJ. Lithum in schizophrenia and schizo-affective disorders.  Br J Psychiatry. 1982;  141 387-400
    PubMedGoogle Scholar
  • 20 Dwight M M, Keck P E, Stanton S P, Strakowski S M, McElroy S L. Antidepressant activity and mania associated with risperidone treatment of schizoaffective disorder.  Lancet. 1994;  344 554-555
    CrossrefPubMedGoogle Scholar
  • 21 Egli H. Erfahrungen mit der Lithiumprophylaxe phasischer affektiver Erkrankungen in einer psychiatrischen Poliklinik.  Schweiz Med Wschr. 1971;  101 157-164
    PubMedGoogle Scholar
  • 22 Emrich H M. Alternatives to lithium prophylaxis for affective and schizoaffective disorders. In: Marneros A, Tsuang MT (Eds.) Affective and Schizoaffective Disorders. Berlin; Springer-Verlag 1990: p. 262-273
    Google Scholar
  • 23 Emrich H M, Dose M, von Zerssen D. The use of sodium valproate, carbamazeoine and oxcarbazepine in patients with affective disorders.  J Affect Disord. 1985;  8 243-250
    CrossrefPubMedGoogle Scholar
  • 24 Faraone S V, Blehar M, Pepple J, Moldin S O, Norton J, Nurnberger J I, Malaspina D, Kaufmann C A, Reich T, Cloninger C R, DePaulo J R, Berg K, Gershon E S, Kirch D G, Tsuang M T. Diagnostic accuracy and confusability analyses: An application to the diagnostic interview for genetic studies.  Psychol Med. 1996;  26 401-410
    PubMedGoogle Scholar
  • 25 Fenn H H, Robinson D, Luby V, Dangel C, Buxton E, Beattie M, Kraemer H, Yesavage J A. Trends in pharmacotherapy of schizoaffective and bipolar affective disorders: A 5-year naturalistic study.  Am J Psychiatry. 1996;  153 711-771
    PubMedGoogle Scholar
  • 26 Frankenburg F R, Zanarini M C. Uses of clozapine in nonschizophrenic patients.  Harvard Rev Psychiatry. 1994;  2 142-150
    PubMedGoogle Scholar
  • 27 Ghaemi S N. New treatments for bipolar disorder: the role of atypical neuroleptic agents.  J Clin Psychiatry. 2000;  61 (suppl 14) 33-42
    PubMedGoogle Scholar
  • 28 Ghaemi N S, Goodwin F K. Use of atypical antipsychotic agents in bipolar and schizoaffective disorders: Review of the empirical literature.  J Clin Psychopharmacol. 1999;  19 354-361
    CrossrefPubMedGoogle Scholar
  • 29 Goodnick P J, Meltzer H Y. Treatment of schizoaffective disorders.  Schizophr Bull. 1984;  10 30-48
    PubMedGoogle Scholar
  • 30 Greil W, Ludwig-Mayerhofer W, Erazo N, Engel R R, Czernik A, Giedcke H, Müller-Oerlinghausen B, Osterheider M, Rudolf G AE, Sauer H, Tegeler J, Wetterling T. Lithium vs. carbamazepine in the maintenance treatment of schizoaffective disorder: a randomised study.  Eur Arch Psychiatry Clin Neurosci. 1997;  247 42-50
    PubMedGoogle Scholar
  • 31 Grossman L S, Harrow M, Goldberg J F, Fichtner C G. Outcome of schizoaffective disorder at two long-term follow-ups: Comparison with outcome of schizophrenia and affective disorders.  Am J Psychiatry. 1991;  148 1359-1365
    PubMedGoogle Scholar
  • 32 Grossman L, Harrow M, Lechert F, Meltzer H Y. The Longitudinal course of schizoaffective disorders.  J Nerv Ment Dis. 1984;  172 140-149
    PubMedGoogle Scholar
  • 33 Hayes S G. Long-term use of valproate in primary psychiatric disorders. J Clin Psychiatry 50 (3, Suppl): 35-39
    Google Scholar
  • 34 Hegarty J D, Baldessarini R J, Tohen M, Waternaux C, Oepen G. One hundred years of schizophrenia: a meta-analysis of the outcome literature.  Am J Psychiatry. 1994;  151 1409-1416
    PubMedGoogle Scholar
  • 35 Hofmann G, Kremser M, Katschnig H, Schreiber V. Prophylaktische Lithiumtherapie bei manisch-depressivem Krankheitsgeschehen und bei Legierungspsychosen.  Int Pharmacopsychiat. 1970;  4 187-193
    PubMedGoogle Scholar
  • 36 Kando J C, Tohen M, Castillo J, Centorrino F. Concurrent use of clozapine and valproate in affective and psychotic disorders.  J Clin Psychiatry. 1994;  55 255-257
    PubMedGoogle Scholar
  • 37 Koufen H, Consbruch U. Langzeitkatamnese zur Frage von Nutzen und Nebenwirkungen der Lithiumprophylaxe der phasischen Psychosen.  Fortschr Neurol Psychiat. 1989;  57 374-382
    PubMedGoogle Scholar
  • 38 Küfferle B, Lenz G. Classification and course of schizo-affective psychoses.  Psychiatrica Clin. 1983;  16 169-177
    PubMedGoogle Scholar
  • 39 Lambert P A. Acute and prophylactic therapies of patients with affective disorderss using valpromide (dipropylacetamide). In: Emrich HM, Kuma T, Müller AA Anticonvulsants in Affective Disorders. Amsterdam; Excerpta Medica 1984: p. 33-44
    Google Scholar
  • 40 Leppig M, Bosch B, Naber D, Hippius H. Clozapine in the treatment of 121 out-patients.  Psychopharmacology (Berl). 1989;  99 S77-79
    CrossrefPubMedGoogle Scholar
  • 41 Levinson D F, Umapathy C, Musthaq M. Treatment of schizoaffective disorder and schizophrenia with mood symptoms.  Am J Psychiatry. 1999;  156 1138-1148
    PubMedGoogle Scholar
  • 42 Levitt J J, Tsuang M T. The heterogeneity of schizoaffective disorder: implications for treatment.  Am J Psychiatry. 1988;  145 926-936
    PubMedGoogle Scholar
  • 43 Lindström L H. A retrospective study on the long-term efficacy of clozapine in 96 schizophrenic and schizoaffective patients during a 13-year period.  Psychopharmacology (Berl). 1989;  99 S84-86
    CrossrefPubMedGoogle Scholar
  • 44 Lowe M R, Batchelor D H. Lithium and neuroleptics in the management of manic depressive psychosis.  Human Psychopharmacology. 1990;  5 267-274
    PubMedGoogle Scholar
  • 45 Maj M, Pirozzi R, Formicula R M, Bartoli L, Bucci P. Reliability and validity of the DSM-IV diagnostic category of schizoaffective disorder: Preliminary data.  J Affect Disord. 2000;  57 95-98
    CrossrefPubMedGoogle Scholar
  • 46 Maj M, Perris C. Patterns of course in patients with a cross-sectional diagnosis of schizoaffective disorder.  J Affect Disord. 1990;  20 71-77
    CrossrefPubMedGoogle Scholar
  • 47 Maj M. Lithium prophylaxis of schizoaffective disorders: a propspective study.  J Affect Disord. 1988;  14 129-135
    CrossrefPubMedGoogle Scholar
  • 48 Mattes J A, Nayak D. Lithium versus fluphenazine for prophylaxis in mainly schizophrenic schizo-affectives.  Biol Psychiatry. 1984;  19 445-449
    PubMedGoogle Scholar
  • 49 McElroy S L, Keck P E, Strakowski S M. An overview of the treatment of schizoaffective disorder.  J Clin Psychiatry. 1999;  60 (Suppl 5) 16-21
    PubMedGoogle Scholar
  • 50 McElroy S L, Dessain E C, Pope H G, Cole J O, Keck P E, Frankenberg F A, Aizley H G, O’Brien S. Clozapine in the treatment of psychotic mood disorders, schizoaffective disorder, and schizophrenia.  J Clin Psychiatry. 1991;  52 411-414
    PubMedGoogle Scholar
  • 51 Minnai G P, Tundo A. Effects of lithium on the course and symptoms of schizo-affective disorder.  Lithium. 1990;  1 191-193
    PubMedGoogle Scholar
  • 52 Narendran R, Young C M, Valenti A M, Pristach C A, Pato M T, Grace J J. Olanzapine therapy in treatment-resistant psychotic mood disorders: a long-term follow-up study.  J Clin Psychiatry. 2001;  62 509-516
    PubMedGoogle Scholar
  • 53 Owen R R, Beake B J, Marby D, Dessain E C, Cole J O. Response to clozapine in chronic psychotic patients.  Psychopharmacology Bull. 1989;  25 253-256
    PubMedGoogle Scholar
  • 54 Perris C. Morbidity Suppressive effect of lithium carbonate in cycloid psychosis. Arch Gen Psychiatry 1978: 328-331
    Google Scholar
  • 55 Perris C, Smigan L. The use of lithium in the long-term morbidity suppressive treatment of cycloid and schizoaffective psychoses. 7th World Congress of Psychiatry.  Pharmacopsychiatry. 1983;  Vol. 3 375-380
    PubMedGoogle Scholar
  • 56 Placidi G F, Lenzi A, Lazzerini F, Cassano G B, Akiskal H S. The comparative efficacy and safety of carbamazepine versus lithium: A randomized, double-blind 3-year trial in 83 patients.  J Clin Psychiatry. 1986;  47 490-494
    PubMedGoogle Scholar
  • 57 Povlsen U J, Noring U, Fog R, Gerlach J. Tolerability and therapeutic effect of clozapine.  Acta Psychiatr Scand. 1985;  71 176-185
    PubMedGoogle Scholar
  • 58 Prien R F, Caffey E M, Klett J. Factors associated with treatment success in lithium carbonate prophylaxis.  Arch Gen Psychiatry. 1974;  31 189-192
    PubMedGoogle Scholar
  • 59 Puzynski S, Klosiewicz L. Valproic acid amide in the treatment of affective and schizoaffective disorders.  J Affect Disord. 1984;  6 15-121
    PubMedGoogle Scholar
  • 60 Romeo R, Bastianello S, Janiri L, Mauro P, Pirrongelli C. Slow-release lithium in the treatment of schizoaffective syndromes.  Int J Clin Pharm Res. 1985;  5 205-211
    PubMedGoogle Scholar
  • 61 Rosenthal N E, Rosenthal L N, Stallone F, Dunner D L, Fieve R R. Toward the validation of RDC schizoaffective disorder.  Arch Gen Psychiatry. 1980;  37 804-810
    PubMedGoogle Scholar
  • 62 Sarantidis D, Waters B. Predictors of lithium prophylaxis effectiveness.  Prog Neuro-Psychopharmacol. 1981;  5 507-510
    PubMedGoogle Scholar
  • 63 Sernyak M J, Woods S W. Chronic antipsychotic use in manic-depressive illness.  Psychopharmacology Bull. 1993;  29 375-381
    PubMedGoogle Scholar
  • 64 Smulevitch A B, Zavidovskaya G I, Igonin A L, Mikhailova N M. The effectiveness of lithium in affective psychoses.  Br J Psychiatry. 1974;  125 65-72
    PubMedGoogle Scholar
  • 65 Spitzer R L, Endicott J, Robins E. Research diagnostic criteria for a selected group of functional disorders. 3rd edn. New York; New York State Psychiatric Institute 1977
    Google Scholar
  • 66 Suppes T, Webb A, Paul B, Carmody T, Kraemer H, Rush J. Clinical outcome in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment resistant illness and a history of mania.  Am J Psychiatry. 1999;  156 1164-1169
    PubMedGoogle Scholar
  • 67 Swoboda E, Conca A, König P, Waanders R, Hansen M. Maintenance Electroconvulsive therapy in affective and schizoaffective disorder.  Neuropsychobiology. 2001;  43 23-28
    PubMedGoogle Scholar
  • 68 Taylor M A. The validity of schizoaffective disorders: Treatment and prevention studies. In: Marneros A, Tsuang MT (eds.) Schizoaffective Psychoses. Berlin; Springer-Verlag 1986: p. 94-114
    Google Scholar
  • 69 Tohen M, Zarate C A. Antipsychotic agents and bipolar disorder.  J Clin. Psychiatry1998;  59 (suppl 1) 38-48
    PubMedGoogle Scholar
  • 70 Torrey E F. Prevalence studies in schizophrenia.  Br J Psychiatry. 1987;  150 598-608
    CrossrefPubMedGoogle Scholar
  • 71 Tran P V, Tollefson G D, Sanger T M, Lu Y, Berg P H, Beasley C M. Olanzapine versus haloperidol in the treatment of schizoaffective disorder.  Br J Psychiatry. 1999;  4 15-22
    PubMedGoogle Scholar
  • 72 Tress W, Haag H. Vergleichende Erfahrungen mit der rezidivprophylaktischen Lithium-Langzeitmedikation bei schizoaffektiven Psychosen.  Nervenarzt. 1979;  50 524-526
    PubMedGoogle Scholar
  • 73 Vieta E, Goikolea J M, Corbella B, Benabarre A, Reinares M, Martinez G, Fernandez A, Colom F, Martinez-Aran A, Torrent C. Risperidone safety and efficacy in the treatment of bipolar and schizoaffective disorders: Results from a 6-month, multicenter, open study.  J Clin Psychiatry. 2001;  62 818-825
    PubMedGoogle Scholar
  • 74 Williams P V, McGlashan T H. Schizoaffective psychosis. I. Comparative long-term outcome.  Arch Gen Psychiatry. 1987;  44 130-137
    PubMedGoogle Scholar
  • 75 World Health Organization. Manual of the international statistical classification of diseases, injuries and causes of death, 8th revision. Geneva; WHO 1965
    Google Scholar
  • 76 World Health Organization. International statistical classification of diseases, injuries and causes of death, 9th Revision. Geneva; WHO 1975
    Google Scholar
  • 77 World Health Organization. The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. Geneva; WHO 1992
    Google Scholar
  • 78 Zarate C A, Tohen M, Banov M D, Weiss M K, Cole J O. Is clozapine a mood stabilizer?.  J Clin Psychiatry. 1995;  56 108-112
    PubMedGoogle Scholar

Christopher Baethge, M.D.

Department of Psychiatry and Psychotherapy

Freie Universität Berlin

Eschenallee 3

14050 Berlin

Germany

Phone: ++49-30-8445-8661

Fax: ++49-30-8445-8378

Email: christopher.baethge@medizin.fu-berlin.de