A panel of schizophrenia experts, including members of the DSM-5 psychosis work group have raised some concern over the inclusion of schizoaffective disorder (SAD) in the diagnostic manual, with one panellist suggesting it may lead to unnecessary prescribing of antipsychotics.
At a symposium on the shifting paradigms of schizophrenia, Dolores Malaspina --a member of the task force in charge of the schizoaffective rewrite -- suggested SAD’s inclusion was partly due to the fact that “clinicians are comfortable” assigning the diagnosis.
Professor of Psychiatry at Harvard Medical School, Matcheri Keshavan agreed this was the case, but worried that “giving it a status of a disorder in DSM-5 is giving license to prescribe antipsychotics more frequently, which is not a good thing”, he told Psychiatry Update.
“My own view is that [SAD] should be in the appendix because it needs to be researched,” he said.
“I’m not convinced we have enough data to warrant its inclusion because if you make it a disorder you’re opening it up to be potentially misused.”
Professor Rajiv Tandon, Professor of Psychiatry at the University of Florida, told Psychiatry Update the cross over between SAD with bipolar and schizophrenia was also an issue.
“At the outset, all the psychotic disorder work group suggested we should get rid of schizoaffective disorder altogether and look at psychotic symptoms and mood across all these disorders including bipolar and schizophrenia and that might help us get a better characterisation but that didn’t go anywhere,” he said.
“I don't see any compelling reason to remove it from DSM-5 – and we’ve got used to it”, Professor Vaughan Carr from the UNSW School of Psychiatry and Chair of Schizophrenia Epidemiology & Population Health agreed.
“As far as clinical practice goes, I think it is often a diagnosis of uncertainty and sometimes a diagnosis of laziness, the default option when the clinician doesn't make enough effort to determine the precise diagnosis,” he said.
Conceding schizoaffective disorder is staying put, Professor Malaspina said the task force focused on improving reliability so clinicians could discern between the diagnoses as well as psychosis risk syndrome.
Kate Aubusson attended APA with an independent educational grant from Pfizer Mental Health