Diagnostic and Treatment Guidelines for Schizoaffective Disorder and Schizophrenia

Diagnostic Criteria

The American Academy of Child and Adolescent Psychiatry recommends that schizophrenia diagnosis requires at least two psychotic symptoms for a significant period during 1 month 2
The American Academy of Child and Adolescent Psychiatry suggests that only one symptom is needed if delusions are bizarre or hallucinations involve running commentary or conversing voices 2
The American Academy of Child and Adolescent Psychiatry states that the duration requirement for schizophrenia is a continuous disturbance for at least 6 months, including at least 1 month of active symptoms 3
The American Academy of Child and Adolescent Psychiatry recommends that social/occupational dysfunction must be markedly below previous levels 3
The American Academy of Child and Adolescent Psychiatry suggests that mood symptoms, if present, are brief relative to the total duration of psychotic illness 1
The American Academy of Child and Adolescent Psychiatry states that schizoaffective disorder must meet full criteria for both schizophrenia and a mood disorder (major depressive or bipolar type) 1
The American Academy of Child and Adolescent Psychiatry recommends that schizoaffective disorder requires a continuous period with psychotic symptoms persisting for at least 2 weeks in the absence of prominent mood symptoms 1

The American Academy of Child and Adolescent Psychiatry recommends that antipsychotic medications are first-line treatment for schizophrenia 6
The American Academy of Child and Adolescent Psychiatry suggests that atypical antipsychotics are preferred over traditional neuroleptics for equivalent efficacy on positive symptoms with better tolerability 6
The American Academy of Child and Adolescent Psychiatry states that adequate therapeutic trials require sufficient dosages over 4-6 weeks 6
The American Academy of Child and Adolescent Psychiatry recommends that clozapine is reserved for treatment-resistant cases after failure of at least two other antipsychotics (one or both should be atypical) 6
The American Academy of Child and Adolescent Psychiatry suggests that first-episode patients should receive maintenance treatment for 1-2 years 6
The American Academy of Child and Adolescent Psychiatry states that combination of pharmacotherapy plus psychosocial interventions is mandatory 6
The American Academy of Child and Adolescent Psychiatry recommends that schizoaffective disorder requires more intensive treatment targeting both mood and psychotic symptoms simultaneously 1

The American Academy of Child and Adolescent Psychiatry states that longitudinal assessment is absolutely essential—misdiagnosis at initial presentation is extremely common, particularly in adolescents where manic episodes frequently present with florid schizophrenia-like symptoms 3
The American Academy of Child and Adolescent Psychiatry recommends that approximately 50% of adolescents with bipolar disorder may be initially misdiagnosed as having schizophrenia 1
The American Academy of Child and Adolescent Psychiatry suggests that a substantial number of youth first diagnosed with schizophrenia actually have bipolar disorder at outcome 4
The American Academy of Child and Adolescent Psychiatry states that systematic reassessment over time is the only accurate method for distinguishing these disorders 3

The American Academy of Child and Adolescent Psychiatry recommends that youth with schizoaffective disorder diagnosed by DSM-IV criteria may have a particularly pernicious form of illness because they meet criteria for both disorders 5

The American Academy of Child and Adolescent Psychiatry states that for any antipsychotic treatment, mandatory documentation includes adequate informed consent from parent/youth 6
The American Academy of Child and Adolescent Psychiatry recommends that specific target symptoms should be documented 2
The American Academy of Child and Adolescent Psychiatry suggests that baseline and follow-up laboratory monitoring (agent-dependent) is necessary 2
The American Academy of Child and Adolescent Psychiatry states that treatment response tracking is essential 2
The American Academy of Child and Adolescent Psychiatry recommends that side effect monitoring (extrapyramidal symptoms, weight gain, agranulocytosis with clozapine, seizures) is crucial 6
The American Academy of Child and Adolescent Psychiatry suggests that dosage adjustments based on illness phase (higher during acute phases, lower during residual phases) should be documented 6