Treatment of schizoaffective disorder and schizophrenia with mood symptoms

Objective: Patients with concurrent schizophrenic and mood symptoms are oft en treated with antipsychotics plus antidepressant or thymoleptic drugs. Th e authors review the literature on treatment of two overlapping groups of p atients: those with schizoaffective disorder and those with schizophrenia a nd concurrent mood symptoms. Method: MEDLINE searches (from 1976 onward) we re undertaken to identify treatment studies of both groups, and references in these reports were checked. Selection of studies for review was based on the use of specified diagnostic criteria and of parallel-group, double-bli nd design (or, where few such studies addressed a particular issue, large o pen studies). A total of 18 treatment studies of schizoaffective disorder a nd 15 of schizophrenia with mood symptoms were selected for review. Results : For acute exacerbations of schizoaffective disorder or of schizophrenia w ith mood symptoms, antipsychotics appeared to be as effective as combinatio n treatments, and there was some evidence for superior efficacy of atypical antipsychotics. There was evidence supporting adjunctive antidepressant tr eatment for schizophrenic and schizoaffective patients who develop a major depressive syndrome after remission of acute psychosis, but there were mixe d results for treatment of subsyndromal depression. There was little eviden ce to support adjunctive lithium for depressive symptoms and no evidence co ncerning its use for manic symptoms in patients with schizophrenia. Conclus ions: Empirical data suggest that both groups of patients are best treated by optimizing antipsychotic treatment and that atypical antipsychotics may prove to be most effective. Adjunctive antidepressants may be useful for pa tients with major depression who are not acutely ill. Careful longitudinal assessment is required to ensure identification of primary mood disorders.