Question. My son has been diagnosed with paranoid schizophrenia. He came out of acute psychosis with depot Prolixin, then out of deep depression with Paxil. Now he functions fairly well in a group home. When he comes home on the weekend he will be happy one moment, then he will talk of suicide and sleep for long periods. Also, he is dually diagnosed with drug abuse, but is now clean. He still maintains some delusions and has specific hygienic practices that he cannot stop. He admits that he has heard voices arguing since he was a small child. Could he be schizoaffective? He seems to have a mixture of several types of mental illness, although I see him as being higher functioning than most of the others in his group.
Answer. I am not in a position to provide a diagnosis of your son, but I will try to give you some general guidance. Schizoaffective disorder (SD) is a rather poorly understood condition, or (more likely) group of conditions. It implies that in addition to the classical symptoms of schizophrenia, such as delusions, hallucinations, disordered thinking and social withdrawal. Individuals with SD usually show periods of either severe depression or mania (a state of extreme agitation, often with euphoric or irritable mood). The person with schizoaffective disorder, by definition, must show at least some period of illness during which delusions or hallucinations are not accompanied by severe depression or mania.
The presence of unusual rituals also raises the question of an obsessive-compulsive component to your son’s illness; the diagnosis of obsessive-compulsive disorder (OCD) would not be made, however, if these rituals are fundamentally related to schizophrenia or psychosis. The bottom line is that your son may not be doing as well as he could be–not if he continues to hear voices, shows prominent mood swings and has periods of suicidality.
It is also possible that a mood stabilizer, such as lithium or valproate, could be useful. I would suggest that you ask your son’s current psychiatrist about these issues, and also consider obtaining a second opinion from an expert in schizophrenia. A medical school-based department of psychiatry would be a good place to start.