14 - Psychological therapies and schizoaffective disorders

Summary

Introduction

This chapter explores psychological therapies in schizoaffective disorders. In order to provide a coherent overview the focus will be exclusively on cognitive behavior therapy (CBT). This approach is the most widely investigated adjunctive therapy for severe mental disorders and there have been large-scale randomized controlled treatment trials (RCTs) in acute and chronic schizophrenia, acute and chronic depression, and in moderately severe and highly recurrent and complex bipolar disorders (for a review, see Roth and Fonagy, 1996). As such, a review of the characteristics of this model – and how this can be applied across the spectrum of severe mood and psychotic disorders – can inform thinking on the benefits and drawbacks of dimensional versus categorical approaches to diagnosis. Interestingly, there are only two small-scale contemporary studies of psychological therapy for schizoaffective disorders (Garety et al., 1994; Theilemann, 1993), so much of the chapter will draw on the experiences reported from the clinical manuals of CBT and the RCTs that have included patients with co-existing psychotic and mood symptoms. These patients are more likely to be found in the RCTs of schizophrenia, as the presence of psychotic symptoms is frequently an exclusion criterion in RCTs of CBT in unipolar or bipolar disorders. Depressed mood is a common accompaniment of all phases of schizophrenia and is often one of the primary outcome measures in RCTs of CBT (Fowler et al., 1995).