What Are the Schizophrenic and the Affective Aspects of Schizoaffective Disorders?

Abstract

Concepts of schizoaffective psychoses differ extensively relative to the criteria used to define their schizophrenic and affective components (Berner and Lenz 1986). These definitions originate not only from pragmatic or empirical considerations, but to a high degrees also from theoretical reflections which must be taken into account if the conceptualization of schizoaffective disorders as a separate entity is to increase scientific insight. The hypotheses about the nature of “psychoses of uncertain origin” have, during the past decades, gradually evolved from the assumption of distinct disease entities towards vulnerability models. The question of whether different types of vulnerability give rise to schizophrenia and mood disorders, or whether the existence of schizoaffective psychoses points to a common basis for both diseases remains open however. All theoretical reflections on this subject must take into account the relationship between changes of mood and activation on the one hand and cognitive disturbances on the other. Braden (1984) reviews this problem with special reference to schizoaffective psychosis and proposes a “two-factor vulnerability model” for it: the first factor is a vulnerability to an episode of psychotic illness characterized by psychomotor and vegetative activation; the second is a vulnerability to disorganization and cognitive disturbance in response to increased activation. Braden demonstrates that this concept is more consistent with clinical observations than other assumptions (such as the separate-process or the single-process model).