Course of Affective and Schizoaffective Disorders

Abstract

In the discussion on the question of how to classify schizoaffective disorders — i.e., as a subgroup of one of the major functional psychoses or as a separate nosological entity — a position often taken in recent years is that schizoaffective disorders appear at least partially to be subtypes of affective disorders (Levinson and Levitt 1987; Sovner and McHugh 1976; Winokur 1984; Winokur et al., this volume). One of the reasons for this point of view is that several studies have shown similarities in course between affective and schizoaffective disorders, for instance, the well-known Zurich studies of Angst and coworkers (Angst 1980; Angst et al. 1973, 1980) or the Cologne Study of Marneros and coworkers (Marneros et al. 1988a–d). Regarding affective disorders, there has been general agreement in recent years that the unipolar and bipolar forms should be investigated separately because of several relevant differences (Angst 1966, 1987). Recent work shows that the subgrouping of schizoaffective disorders — similarly to affective disorders — into unipolar and bipolar forms is also indicated (Angst 1989, Marneros et al. 1989a–c). The differentiation between unipolar and bipolar forms of affective and schizoaffective disorders is necessary not only because of relevant differences in premorbid, sociodemographic, and therapeutic aspects, but also considering the longitudinal approach. Conversely, the division of schizoaffective disorders into schizodepression and schizomania (Brockington et al. 1980; Maj 1985) has the disadvantage of taking only the cross-sectional aspect into consideration (Marneros et al. 1986a–c, 1989b). The division of affective and schizoaffective disorders into unipolar and bipolar forms also solves the problem of syndrome shift and polymorphism of the course (Marneros et al. 1988d).