Can schizophrenia be mistaken for schizoaffective disorder?

Question

Hello doctor,

I am 36 years old and was diagnosed with schizophrenia a few years ago. I have been taking Olanzapine since then.

Recently, I moved to a new place, and when I consulted a psychiatrist here, they said it might actually be schizoaffective disorder instead. I am feeling very confused. Kindly tell me the following:

Can schizophrenia be mistaken for schizoaffective disorder, even at the age of 36?
Does this mean I have been taking the wrong medication all these years?
I do experience mood swings along with hearing voices. Does changing the diagnosis also change the treatment?

I am worried that I may have been treated for the wrong illness all this time. I just want to understand what is actually happening to me.

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out.

I can understand why this change in diagnosis feels confusing and worrying. Please be reassured that it is not uncommon for the diagnosis to change over time as doctors gather more information about how a person's symptoms develop.

The difference between schizophrenia and schizoaffective disorder is based on a specific pattern of symptoms over time, not just on having individual symptoms.

Schizophrenia is a mental health condition that mainly affects how a person thinks, feels, and perceives reality. Common symptoms include hearing voices (auditory hallucinations), seeing or believing things that are not real (hallucinations and delusions), disorganised thinking, and reduced motivation or emotional expression.

Schizoaffective disorder includes these schizophrenia symptoms, but it also involves a significant mood disorder, such as depression (persistent low mood, loss of interest, low energy, and feelings of hopelessness) or mania (an unusually elevated or irritable mood, increased energy, reduced need for sleep, rapid speech, impulsive behaviour, and inflated self-confidence). These mood episodes must occur for a sufficient duration and meet established diagnostic criteria.

When you were first diagnosed with schizophrenia, your symptoms may not have met the criteria for a separate mood disorder. As time passes, new symptoms can appear or become more obvious, allowing your psychiatrist to make a more accurate diagnosis.

This does not necessarily mean that your previous diagnosis was wrong. Mental health conditions can evolve, and sometimes the diagnosis becomes clearer with long-term follow-up.

Regarding your treatment, there is no need to worry. Olanzapine is an antipsychotic medication, meaning it helps control symptoms such as hearing voices, delusions, and disturbed thinking. It can also help stabilise mood in some people.

If you have significant symptoms of depression or mania, your psychiatrist may recommend adding another medication, such as an antidepressant (to treat depression) or a mood stabiliser (a medicine that helps prevent extreme mood swings), depending on your symptoms.

Since you mentioned experiencing mood swings along with hearing voices, it would be helpful for your psychiatrist to understand exactly what those mood changes are like, how long they last, and whether they occur at the same time as, or separately from, the psychotic symptoms.

This information helps distinguish between schizophrenia and schizoaffective disorder and guides the most appropriate treatment.

I hope this helps.

Please revert in case of further queries.

Thank you.