Schizophrenia and Schizoaffective are Psychotic Mood Disorders

By Daniel J. Aires, MD, JD; Nathaniel G. Hurwitz, MD

More than 110 years ago, Kraepelin defined two separate functional psychoses: schizophrenia and bipolar illness. One hundred years ago, Bleuler asserted that schizophrenia was defined by the presence of a single psychotic symptom. Seventy-five years ago, Kasanin coined the term “schizoaffective” to describe blatant mood disorder in schizophrenic patients. Schizoaffective appeared in the 1952 Diagnostic and Statistical Manual of Mental Disorders (DSM), gained momentum in the 1970s, and is still in use today, despite the lack of reliable diagnostic criteria. Although it dates from the pre-scientific era, schizoaffective provides a bridge toward the scientifically based view that a single disease with a spectrum of severity accounts for all functional psychosis. This single disease is psychotic mood disorder. The “single-disease model” is based on large bodies of genetic, pharmacologic, and behavioral data. This modern view encourages research into neuroprotective interventions for treating populations that are susceptible to major mental illness.

ABOUT THE AUTHOR

Daniel J. Aires, MD, JD, is Stiefel Professor of Dermatology, and Director, Division of Dermatology, University of Kansas School of Medicine, Kansas City, Kansas.

Address correspondence to: Daniel J. Aires, MD, JD, University of Kansas School of Medicine, 3901 Rainbow Blvd., M.S. 2025, Kansas City, KS 66161; or e-mail: daires@kumc.edu.

Dr. Aires and Dr. Hurwitz have disclosed no relevant financial relationships.

doi: 10.3928/00485718-20100127-06

EDUCATIONAL OBJECTIVES

1. Review the historical reasons for splitting functional psychotic illness into “schizophrenia,” and “schizoaffective disorder,” and “psychotic mood disorder.”

2. Describe the modern data that link “schizophrenia,” and “schizoaffective disorder,” and “psychotic mood disorder” into a single illness with a spectrum of severity.

3. Cite the potential to harm patients by splitting functional psychotic illness into “schizophrenia,” and “schizoaffective disorder,” and “psychotic mood disorder.”

This CME activity is primarily targeted to patient-caring physicians specializing in psychiatry. Physicians can receive AMA PRA Category 1 Credits™ by reading the CME articles in Psychiatric Annals and successfully completing the quiz at the end of the articles. Complete instructions are given subsequently. Educational objectives are found at the beginning of each CME article.

CME ACCREDITATION

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Vindico Medical Education and Psychiatric Annals. Vindico Medical Education is accredited by the ACCME to provide continuing medical education for physicians.

Vindico Medical Education designates this educational activity for a maximum of 3 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

FULL DISCLOSURE POLICY

In accordance with the Accreditation Council for Continuing Medical Education's Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears at the beginning of each CME-accredited article in this issue.

UNLABELED AND INVESTIGATIONAL USAGE

The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage.

RESPONSIBILITY FOR STATEMENTS

All opinions expressed by authors and quoted sources are their own and do not necessarily reflect the opinions of the editors, publishers, or editorial boards of Psychiatric Annals or its employees, Vindico Medical Education or its employees, or the University of New Mexico. The acceptance of advertising in no way implies endorsement by the editors, publishers, or editorial boards of Psychiatric Annals.

The material presented at or in any Psychiatric Annals or Vindico Medical Education continuing education activity does not necessarily reflect the views and opinions of Vindico Medical Education or Psychiatric Annals. Neither Psychiatric Annals, Vindico Medical Education, nor the faculty endorse or recommend any techniques, commercial products, or manufacturers. The faculty/authors may discuss the use of materials and/or products that have not yet been approved by the U.S. Food and Drug Administration. Articles are intended for informational purposes only and should not be used as the basis of patient treatment. All readers and continuing education participants should verify all information before treating patients or utilizing any product.

Copyright © 2009 by SLACK Incorporated. All rights reserved. No part of this publication may be reproduced without prior written consent of the publisher.

INSTRUCTIONS

1. Review the stated learning objectives of the CME articles and determine if these objectives match your individual learning needs. You must read each of the CME articles in this issue carefully in order to take the quiz. Do not neglect the tables and other illustrative materials as they have been selected to enhance your knowledge and understanding.
2. The cost of taking the CME quiz is $25; you must pay this fee prior to completing the quiz online.
3. The quiz questions have been designed to provide a useful link between the CME articles in the issue and your everyday practice. Read each question and choose the correct answer by checking the box next to your desired answer.
4. After you answer all questions, your quiz is graded. A score of at least 80% is required to pass
5. If you passed the quiz, you will receive by mail a CME certificate of within 4 to 6 weeks. If you failed the quiz, you may retake the quiz at another time by returning to the CME articles and then registering again for the quiz.

| | |

Schizophrenia and Bipolar Disorder: No Dichotomy, a Continuum, or One Disease?
C. Ray Lake, MD, PhD

The Psychotic Continuum: Follow the Evidence, but How is it Interpreted?
Jan Fawcett, MD

Schizophrenia and Bipolar Disorder:No Dichotomy, A Continuum, or One Disease?
C. Ray Lake, MD, PhD

 The Validity of Schizophrenia vs. Bipolar Disorder
C. Ray Lake, MD, PhD

 Molecular Genetics and the Kraepelinian Dichotomy: One Disorder, Two Disorders, or Do We Need to Start Thinking Afresh?
Nick Craddock, MA, MD, MmedSci, PhD, FRCPsych; Michael J. Owen

 Psychotic Depression or Schizophrenia
Conrad M. Swartz, PhD, MD

Overlaps between Schizophrenia and Bipolar Disorder
Robert M. Post, MD

The Continuum of Psychosis — 1986-2010
Timothy J. Crow, MBBS, PhD, FRCP, FRCPsych, FMedSci