{"id":858,"date":"2020-08-11T11:19:27","date_gmt":"2020-08-11T11:19:27","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=858"},"modified":"2022-07-26T20:06:29","modified_gmt":"2022-07-26T20:06:29","slug":"schizoaffective-disorder","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/schizoaffective-disorder\/","title":{"raw":"Schizoaffective Disorder","rendered":"Schizoaffective Disorder"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Describe the symptoms, etiology, and management of schizoaffective disorder<\/li>\r\n<\/ul>\r\n<\/div>\r\n<strong>Schizoaffective disorder (SD) <\/strong>is a mental disorder characterized by both ongoing psychosis and significant symptoms of mood disorders. The diagnosis is made when the person has symptoms of both schizophrenia (usually psychosis) and a mood disorder\u2014either bipolar disorder or depression. The main criterion for the schizoaffective disorder diagnosis that separates it from a mood disorder diagnosis is the presence of psychotic symptoms for at least two weeks without any mood symptoms present. The \"main\" disorder most resembles schizophrenia, and while the mood disorder may come and go, elements of psychosis are always present. This differs from a mood disorder with psychotic features, which is predominately a mood disorder where elements of psychosis sometimes flare up, such as during a manic episode.[footnote]Malaspina D, Owen MJ, Heckers S, Tandon R, Bustillo J, Schultz S, Barch DM, Gaebel W, Gur RE, Tsuang M, Van Os J, Carpenter W (May 2013). \"Schizoaffective disorder in the DSM-5\". <em>Schizophrenia Research<\/em>. 150 (1): 21\u20135. doi:10.1016\/j.schres.2013.04.026. PMID 23707642. S2CID 14770729.[\/footnote]\u00a0Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be\u00a0a major depressive episode or bipolar disorder with mood-congruent or mood-incongruent psychotic features.\r\n\r\n[caption id=\"attachment_4221\" align=\"alignright\" width=\"224\"]<img class=\"wp-image-4221\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/07014536\/spirit-cemetery-church-haunted-300x300.jpg\" alt=\"A rendered image of a spirit or ghost in a cemetary.\" width=\"224\" height=\"224\" \/> <strong>Figure 1.\u00a0<\/strong>Schizoaffective disorder includes typical features of schizophrenia, combined with features of major mood episodes.[\/caption]\r\n<h2>Diagnosis<\/h2>\r\nThe specific DSM-5 criteria for schizoaffective disorder are as follows: [footnote]Tandon R, Gaebel W, Barch DM, Bustillo J, Gur RE, Heckers S, Malaspina D, Owen MJ, Schultz S, Tsuang M, Van Os J, Carpenter W. Definition and description of schizophrenia in the DSM-5. Schizophr. Res. 2013 Oct;150(1):3-10. [PubMed] [Reference list][\/footnote]\r\n<p style=\"padding-left: 30px;\">A. An uninterrupted duration of illness during which there is a major mood episode (manic or depressive) in addition to criterion A for schizophrenia; the major depressive episode must include depressed mood. Criterion A for schizophrenia is as follows:<\/p>\r\n<p style=\"padding-left: 30px;\">Two or more of the following presentations, each present for a significant amount of time during a one-month period (or less if successfully treated). At least one of these must be from the first three below:<\/p>\r\n\r\n<ul>\r\n \t<li>delusions<\/li>\r\n \t<li>hallucinations<\/li>\r\n \t<li>disorganized speech (e.g., frequent derailment or incoherence).<\/li>\r\n \t<li>grossly disorganized or catatonic behavior<\/li>\r\n \t<li>negative symptoms (i.e., diminished emotional expression or avolition)<\/li>\r\n<\/ul>\r\n<p style=\"padding-left: 30px;\">B. Hallucinations and delusions for two or more weeks in the absence of a major mood episode (manic or depressive) during the entire lifetime duration of the illness.<\/p>\r\n<p style=\"padding-left: 30px;\">C. Symptoms that meet the criteria for a major mood episode are present for the majority of the total duration of the active as well as residual portions of the illness.<\/p>\r\n<p style=\"padding-left: 30px;\">D. The disturbance is not the result of the effects of a substance (e.g., drug abuse or a medication) or another underlying medical condition.<\/p>\r\nThe following are specifiers based on the primary mood episode as part of the presentation:\r\n<ul>\r\n \t<li>bipolar type: includes episodes of mania and sometimes major depression<\/li>\r\n \t<li>depressive type: includes only major depressive episodes<\/li>\r\n<\/ul>\r\nA patient must meet the criteria for A\u2013D above to be diagnosed with schizoaffective disorder.\r\n\r\nSchizoaffective disorder is one of the most misdiagnosed psychiatric disorders in clinical practice. In fact, some researchers have proposed revisions to the diagnostic criteria, while others have suggested removing the diagnosis from the DSM-5. The challenges lie within the diagnostic criteria itself, since the disorder is part of a spectrum that shares criteria with many other prominent psychiatric disorders found in clinical practice.\r\n<h3>Differential Diagnosis<\/h3>\r\nDue to having criteria that encompass both psychotic and mood symptoms, schizoaffective disorder is easy to mistake for other mental disorders. Disorders that must be ruled out during the workup of schizoaffective disorder include:\r\n<ul>\r\n \t<li>schizophrenia<\/li>\r\n \t<li>major depressive disorder (MDD) with psychotic features<\/li>\r\n \t<li>bipolar disorder with psychotic features<\/li>\r\n<\/ul>\r\nThere has to be a definite period of at least two weeks in which there are only psychotic symptoms (delusions and hallucinations) without mood symptoms to diagnose schizoaffective disorder. However, a major mood episode (depression or mania) is present for the majority of the total duration of the illness. If the psychotic symptoms predominate the majority of the total duration of the illness, the diagnosis leans towards schizophrenia. Also, schizophrenia requires six months of prodromal or residual symptoms; schizoaffective disorder does not require this criterion.\r\n\r\nPatients with major depression with psychotic features (MDD with PF), only experience psychotic features during their mood episodes. In contrast, schizoaffective requires at least two weeks in which there are only psychotic symptoms (delusions and hallucinations) without mood symptoms. Patients with MDD with psychotic features do not meet criterion A of schizoaffective disorder.\r\n\r\nSimilar to the contrasts with MDD with psychotic features, patients with bipolar disorder with psychotic features only experience psychotic features (delusions and hallucinations) during a manic episode. Again, schizoaffective disorder requires a period of at least two weeks in which there are only psychotic symptoms without mood symptoms. Psychotic features in bipolar disorder do not meet criterion A of schizoaffective disorder.\r\n<div class=\"textbox examples\">\r\n<h3>WAtcH It<\/h3>\r\nThis video explains more about the diagnostic criteria and symptoms of schizoaffective disorder.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=5576195&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=nHsS3Ta2MQo&amp;video_target=tpm-plugin-af1dgswi-nHsS3Ta2MQo\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/SchizoaffectiveDisorderWhatIsIt_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"Schizoaffective Disorder?...What is it?\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<h2>Etiology<\/h2>\r\nThe term <em>schizoaffective disorder<\/em> first appeared as a subtype of schizophrenia in the first edition of the DSM. Schizoaffective disorder eventually became its own diagnosis despite a lack of evidence for unique differences in etiology or physiological processes. Therefore, there have been no conclusive studies on the etiology of the disorder. However, investigating the potential causes of mood disorders and schizophrenia as individual disorders allows for further discussion.\r\n\r\nSome studies show that as high as 50% of people with schizophrenia also have comorbid depression. The etiology of both mood disorders and schizophrenia is multifactorial (remember the biopsychosocial model) and covers a range of risk factors including genetics, social factors, trauma, and stress. Among people with schizophrenia, there is a possible increased risk for first-degree relatives to develop schizoaffective disorder and vice-versa; there may also be increased risk among individuals for schizoaffective disorder who have a first-degree relative with bipolar disorder, schizophrenia, or schizoaffective disorder.\r\n<h2>Treatment\/Management<\/h2>\r\nThe treatment of schizoaffective disorder typically involves both pharmacotherapy and psychotherapy. The mainstay of most treatment regimens should include an antipsychotic, but the choice of treatment should be tailored to the individual. A study that reported obtained data on treatment regimens for schizoaffective showed that 93% of patients received an antipsychotic. Twenty percent of patients received a mood-stabilizer in addition to an antipsychotic, while 19% received an antidepressant along with an antipsychotic. [footnote]Cascade E, Kalali AH, Buckley P. Treatment of schizoaffective disorder. Psychiatry (Edgmont). 2009 Mar;6(3):15-7. [PMC free article] [PubMed] [Reference list][\/footnote] Prior to initiating treatment, if a patient with schizoaffective disorder is a danger to themselves or others, inpatient hospitalization should be considered; this includes patients who are neglecting activities of daily living or those who are disabled well below their baseline in terms of functioning.\r\n<h3>Pharmacotherapy<\/h3>\r\n[caption id=\"attachment_4223\" align=\"alignright\" width=\"271\"]<img class=\"wp-image-4223\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/07015723\/1024px-Risperdal_Consta_injection_syringe-300x278.jpg\" alt=\"Risperidone antipsychotic medication in syringe form.\" width=\"271\" height=\"251\" \/> <strong>Figure 2.<\/strong> Antipsychotics medications can come as syrups, pills, or injections.[\/caption]\r\n<h4><strong>Antipsychotics<\/strong><\/h4>\r\nAntipsychotics are used to target psychosis and aggressive behavior in schizoaffective disorder. Other symptoms include delusions, hallucinations, negative symptoms, disorganized speech, and behavior. Most first- and second-generation antipsychotics block dopamine receptors while second-generation antipsychotics have further actions on serotonin receptors. Antipsychotics include, but are not limited to paliperidone (FDA approved for schizoaffective disorder), risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and haloperidol. Clozapine is a consideration for refractory cases, much like in schizophrenia.\r\n<h4>Mood-stabilizers<\/h4>\r\nPatients who have periods of distractibility, indiscretion, grandiosity, a flight of ideas, increased goal-directed activity, and decreased need for sleep, and who are hyper-verbal fall under the bipolar specifier for schizoaffective disorder. Consider the use of mood stabilizers if the patient has a history of manic or hypomanic symptoms. These include medications such as lithium, valproic acid, carbamazepine, oxcarbazepine, and lamotrigine, which target mood dysregulation.\r\n<h4>Antidepressants<\/h4>\r\nUsed to target depressive symptoms in schizoaffective disorder. Selective-serotonin reuptake inhibitors (SSRIs) are preferred due to lower risk for adverse drug effects and tolerability when compared to tricyclic antidepressants and selective norepinephrine reuptake inhibitors. SSRIs include fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine. It is vital to rule out bipolar disorder before starting an antidepressant due to the risk of exacerbating a manic episode.\r\n<h3>Psychotherapy<\/h3>\r\nPatients who have schizoaffective disorder can benefit from psychotherapy, as is the case with most mental disorders. Treatment plans should incorporate individual therapy, family therapy, and psychoeducational programs. The aim is to develop their social skills and improve cognitive functioning to prevent relapse and possible rehospitalization. This treatment plan includes education about the disorder, etiology, and treatment.\r\n\r\nIndividual therapy aims to normalize thought processes and better help the patient understand the disorder to reduce the burden of symptoms. Sessions focus on everyday goals, social interactions, social skills training, and vocational training.\r\n\r\nFamily involvement is crucial in the treatment of this schizoaffective disorder. Family education aids in compliance with medications and appointments, and helps provide structure throughout the patient's life given the dynamic nature of the schizoaffective disorder. Supportive group programs can also help if the patient has been in social isolation and provides a sense of shared experiences among participants.\r\n<h4>Electroconvulsive Therapy<\/h4>\r\n[caption id=\"attachment_4225\" align=\"alignright\" width=\"272\"]<img class=\"wp-image-4225\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/07020824\/1024px-MECTA_spECTrum_ECT-300x228.jpg\" alt=\"A modern ECT machine in a hospital. It's white and rectangular with numerous knobs and controls as well as a small screen. Wires are plugged into it. \" width=\"272\" height=\"207\" \/> <strong>Figure 3.<\/strong>\u00a0 A modern ECT machine.[\/caption]\r\n\r\nElectroconvulsive therapy (ECT) is usually a last resort treatment. ECT is typically administered by a psychiatrist, an anesthesiologist, and a nurse, as it consists of electrical stimulation to the brain while the patient is under anesthesia. However, not only has ECT been used in urgent cases and treatment resistance, but it should also merit consideration in augmentation of current pharmacotherapy. The most common indicated symptoms are catatonia and aggression. ECT is safe and effective for most chronically hospitalized patients.\r\n<h4>Prognosis<\/h4>\r\nGiven that the diagnostic criteria of schizoaffective disorder change periodically, prognostic studies have been challenging to conduct. However, a study by Harrison et al., 2001 on the overall prognosis of those with psychotic illness showed that 50% of cases showed favorable outcomes.[footnote]Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube KC, Ganev K, Giel R, an der Heiden W, Holmberg SK, Janca A, Lee PW, Le\u00f3n CA, Malhotra S, Marsella AJ, Nakane Y, Sartorius N, Shen Y, Skoda C, Thara R, Tsirkin SJ, Varma VK, Walsh D, Wiersma D. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry. 2001 Jun;178:506-17. [PubMed] [Reference list][\/footnote] This study defined a favorable outcome as minimal or no symptoms, and\/or employment. These outcomes were highly reliant on early initiation of treatment and optimized treatment regimens as described above.\r\n\r\nLeft untreated, schizoaffective disorder has many ramifications in both social functioning and activities of daily living, including unemployment, isolation, impaired ability to care for self, etc. Untreated mental disorders have more than just social and functional consequences. Some studies show that as many as 5% of people with a psychotic illness will commit suicide over their lifetime.[footnote]Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. J. Psychopharmacol. (Oxford). 2010 Nov;24(4 Suppl):81-90. [PMC free article] [PubMed] [Reference list][\/footnote] Research has shown that among all completed suicides, 10% are attributable to those with a psychotic illness.\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nThis video tells the story of Juan, who talks about how he's managed his schizoaffective disorder diagnosis through an early treatment program.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=5576196&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=WWItoZNFGwY&amp;video_target=tpm-plugin-nc3i1jqn-WWItoZNFGwY\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/SchizoaffectiveDisorderJuansStory_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"Schizoaffective disorder: Juan's Story\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Key Takeaways: Schizoaffective Disorder<\/h3>\r\n<iframe title=\"49. Schizoaffective Disorder\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291235872141185668\/embed\" width=\"1088\" height=\"435\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script>\r\n\r\n[footnote]Hans-Jorg A, Bianca U (2020) Schizoaffective Disorder: A Challenge. J Aging Sci. 8: 221. Doi:10.35248\/2329-8847.20.08.221.[\/footnote]\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/e7f478a1-86b8-4528-9e64-e1aba201dbf9\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>electroconvulsive therapy: <\/strong>last resort treatment which\u00a0involves a brief electrical stimulation of the brain while the patient is under anesthesia\r\n\r\n<strong>schizoaffective disorder:\u00a0<\/strong>a mental disorder characterized by abnormal thought processes and unstable moods\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Describe the symptoms, etiology, and management of schizoaffective disorder<\/li>\n<\/ul>\n<\/div>\n<p><strong>Schizoaffective disorder (SD) <\/strong>is a mental disorder characterized by both ongoing psychosis and significant symptoms of mood disorders. The diagnosis is made when the person has symptoms of both schizophrenia (usually psychosis) and a mood disorder\u2014either bipolar disorder or depression. The main criterion for the schizoaffective disorder diagnosis that separates it from a mood disorder diagnosis is the presence of psychotic symptoms for at least two weeks without any mood symptoms present. The &#8220;main&#8221; disorder most resembles schizophrenia, and while the mood disorder may come and go, elements of psychosis are always present. This differs from a mood disorder with psychotic features, which is predominately a mood disorder where elements of psychosis sometimes flare up, such as during a manic episode.<a class=\"footnote\" title=\"Malaspina D, Owen MJ, Heckers S, Tandon R, Bustillo J, Schultz S, Barch DM, Gaebel W, Gur RE, Tsuang M, Van Os J, Carpenter W (May 2013). &quot;Schizoaffective disorder in the DSM-5&quot;. Schizophrenia Research. 150 (1): 21\u20135. doi:10.1016\/j.schres.2013.04.026. PMID 23707642. S2CID 14770729.\" id=\"return-footnote-858-1\" href=\"#footnote-858-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a>\u00a0Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be\u00a0a major depressive episode or bipolar disorder with mood-congruent or mood-incongruent psychotic features.<\/p>\n<div id=\"attachment_4221\" style=\"width: 234px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4221\" class=\"wp-image-4221\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/07014536\/spirit-cemetery-church-haunted-300x300.jpg\" alt=\"A rendered image of a spirit or ghost in a cemetary.\" width=\"224\" height=\"224\" \/><\/p>\n<p id=\"caption-attachment-4221\" class=\"wp-caption-text\"><strong>Figure 1.\u00a0<\/strong>Schizoaffective disorder includes typical features of schizophrenia, combined with features of major mood episodes.<\/p>\n<\/div>\n<h2>Diagnosis<\/h2>\n<p>The specific DSM-5 criteria for schizoaffective disorder are as follows: <a class=\"footnote\" title=\"Tandon R, Gaebel W, Barch DM, Bustillo J, Gur RE, Heckers S, Malaspina D, Owen MJ, Schultz S, Tsuang M, Van Os J, Carpenter W. Definition and description of schizophrenia in the DSM-5. Schizophr. Res. 2013 Oct;150(1):3-10. [PubMed] [Reference list]\" id=\"return-footnote-858-2\" href=\"#footnote-858-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<p style=\"padding-left: 30px;\">A. An uninterrupted duration of illness during which there is a major mood episode (manic or depressive) in addition to criterion A for schizophrenia; the major depressive episode must include depressed mood. Criterion A for schizophrenia is as follows:<\/p>\n<p style=\"padding-left: 30px;\">Two or more of the following presentations, each present for a significant amount of time during a one-month period (or less if successfully treated). At least one of these must be from the first three below:<\/p>\n<ul>\n<li>delusions<\/li>\n<li>hallucinations<\/li>\n<li>disorganized speech (e.g., frequent derailment or incoherence).<\/li>\n<li>grossly disorganized or catatonic behavior<\/li>\n<li>negative symptoms (i.e., diminished emotional expression or avolition)<\/li>\n<\/ul>\n<p style=\"padding-left: 30px;\">B. Hallucinations and delusions for two or more weeks in the absence of a major mood episode (manic or depressive) during the entire lifetime duration of the illness.<\/p>\n<p style=\"padding-left: 30px;\">C. Symptoms that meet the criteria for a major mood episode are present for the majority of the total duration of the active as well as residual portions of the illness.<\/p>\n<p style=\"padding-left: 30px;\">D. The disturbance is not the result of the effects of a substance (e.g., drug abuse or a medication) or another underlying medical condition.<\/p>\n<p>The following are specifiers based on the primary mood episode as part of the presentation:<\/p>\n<ul>\n<li>bipolar type: includes episodes of mania and sometimes major depression<\/li>\n<li>depressive type: includes only major depressive episodes<\/li>\n<\/ul>\n<p>A patient must meet the criteria for A\u2013D above to be diagnosed with schizoaffective disorder.<\/p>\n<p>Schizoaffective disorder is one of the most misdiagnosed psychiatric disorders in clinical practice. In fact, some researchers have proposed revisions to the diagnostic criteria, while others have suggested removing the diagnosis from the DSM-5. The challenges lie within the diagnostic criteria itself, since the disorder is part of a spectrum that shares criteria with many other prominent psychiatric disorders found in clinical practice.<\/p>\n<h3>Differential Diagnosis<\/h3>\n<p>Due to having criteria that encompass both psychotic and mood symptoms, schizoaffective disorder is easy to mistake for other mental disorders. Disorders that must be ruled out during the workup of schizoaffective disorder include:<\/p>\n<ul>\n<li>schizophrenia<\/li>\n<li>major depressive disorder (MDD) with psychotic features<\/li>\n<li>bipolar disorder with psychotic features<\/li>\n<\/ul>\n<p>There has to be a definite period of at least two weeks in which there are only psychotic symptoms (delusions and hallucinations) without mood symptoms to diagnose schizoaffective disorder. However, a major mood episode (depression or mania) is present for the majority of the total duration of the illness. If the psychotic symptoms predominate the majority of the total duration of the illness, the diagnosis leans towards schizophrenia. Also, schizophrenia requires six months of prodromal or residual symptoms; schizoaffective disorder does not require this criterion.<\/p>\n<p>Patients with major depression with psychotic features (MDD with PF), only experience psychotic features during their mood episodes. In contrast, schizoaffective requires at least two weeks in which there are only psychotic symptoms (delusions and hallucinations) without mood symptoms. Patients with MDD with psychotic features do not meet criterion A of schizoaffective disorder.<\/p>\n<p>Similar to the contrasts with MDD with psychotic features, patients with bipolar disorder with psychotic features only experience psychotic features (delusions and hallucinations) during a manic episode. Again, schizoaffective disorder requires a period of at least two weeks in which there are only psychotic symptoms without mood symptoms. Psychotic features in bipolar disorder do not meet criterion A of schizoaffective disorder.<\/p>\n<div class=\"textbox examples\">\n<h3>WAtcH It<\/h3>\n<p>This video explains more about the diagnostic criteria and symptoms of schizoaffective disorder.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=5576195&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=nHsS3Ta2MQo&amp;video_target=tpm-plugin-af1dgswi-nHsS3Ta2MQo\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/SchizoaffectiveDisorderWhatIsIt_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;Schizoaffective Disorder?&#8230;What is it?&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<h2>Etiology<\/h2>\n<p>The term <em>schizoaffective disorder<\/em> first appeared as a subtype of schizophrenia in the first edition of the DSM. Schizoaffective disorder eventually became its own diagnosis despite a lack of evidence for unique differences in etiology or physiological processes. Therefore, there have been no conclusive studies on the etiology of the disorder. However, investigating the potential causes of mood disorders and schizophrenia as individual disorders allows for further discussion.<\/p>\n<p>Some studies show that as high as 50% of people with schizophrenia also have comorbid depression. The etiology of both mood disorders and schizophrenia is multifactorial (remember the biopsychosocial model) and covers a range of risk factors including genetics, social factors, trauma, and stress. Among people with schizophrenia, there is a possible increased risk for first-degree relatives to develop schizoaffective disorder and vice-versa; there may also be increased risk among individuals for schizoaffective disorder who have a first-degree relative with bipolar disorder, schizophrenia, or schizoaffective disorder.<\/p>\n<h2>Treatment\/Management<\/h2>\n<p>The treatment of schizoaffective disorder typically involves both pharmacotherapy and psychotherapy. The mainstay of most treatment regimens should include an antipsychotic, but the choice of treatment should be tailored to the individual. A study that reported obtained data on treatment regimens for schizoaffective showed that 93% of patients received an antipsychotic. Twenty percent of patients received a mood-stabilizer in addition to an antipsychotic, while 19% received an antidepressant along with an antipsychotic. <a class=\"footnote\" title=\"Cascade E, Kalali AH, Buckley P. Treatment of schizoaffective disorder. Psychiatry (Edgmont). 2009 Mar;6(3):15-7. [PMC free article] [PubMed] [Reference list]\" id=\"return-footnote-858-3\" href=\"#footnote-858-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a> Prior to initiating treatment, if a patient with schizoaffective disorder is a danger to themselves or others, inpatient hospitalization should be considered; this includes patients who are neglecting activities of daily living or those who are disabled well below their baseline in terms of functioning.<\/p>\n<h3>Pharmacotherapy<\/h3>\n<div id=\"attachment_4223\" style=\"width: 281px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4223\" class=\"wp-image-4223\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/07015723\/1024px-Risperdal_Consta_injection_syringe-300x278.jpg\" alt=\"Risperidone antipsychotic medication in syringe form.\" width=\"271\" height=\"251\" \/><\/p>\n<p id=\"caption-attachment-4223\" class=\"wp-caption-text\"><strong>Figure 2.<\/strong> Antipsychotics medications can come as syrups, pills, or injections.<\/p>\n<\/div>\n<h4><strong>Antipsychotics<\/strong><\/h4>\n<p>Antipsychotics are used to target psychosis and aggressive behavior in schizoaffective disorder. Other symptoms include delusions, hallucinations, negative symptoms, disorganized speech, and behavior. Most first- and second-generation antipsychotics block dopamine receptors while second-generation antipsychotics have further actions on serotonin receptors. Antipsychotics include, but are not limited to paliperidone (FDA approved for schizoaffective disorder), risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and haloperidol. Clozapine is a consideration for refractory cases, much like in schizophrenia.<\/p>\n<h4>Mood-stabilizers<\/h4>\n<p>Patients who have periods of distractibility, indiscretion, grandiosity, a flight of ideas, increased goal-directed activity, and decreased need for sleep, and who are hyper-verbal fall under the bipolar specifier for schizoaffective disorder. Consider the use of mood stabilizers if the patient has a history of manic or hypomanic symptoms. These include medications such as lithium, valproic acid, carbamazepine, oxcarbazepine, and lamotrigine, which target mood dysregulation.<\/p>\n<h4>Antidepressants<\/h4>\n<p>Used to target depressive symptoms in schizoaffective disorder. Selective-serotonin reuptake inhibitors (SSRIs) are preferred due to lower risk for adverse drug effects and tolerability when compared to tricyclic antidepressants and selective norepinephrine reuptake inhibitors. SSRIs include fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine. It is vital to rule out bipolar disorder before starting an antidepressant due to the risk of exacerbating a manic episode.<\/p>\n<h3>Psychotherapy<\/h3>\n<p>Patients who have schizoaffective disorder can benefit from psychotherapy, as is the case with most mental disorders. Treatment plans should incorporate individual therapy, family therapy, and psychoeducational programs. The aim is to develop their social skills and improve cognitive functioning to prevent relapse and possible rehospitalization. This treatment plan includes education about the disorder, etiology, and treatment.<\/p>\n<p>Individual therapy aims to normalize thought processes and better help the patient understand the disorder to reduce the burden of symptoms. Sessions focus on everyday goals, social interactions, social skills training, and vocational training.<\/p>\n<p>Family involvement is crucial in the treatment of this schizoaffective disorder. Family education aids in compliance with medications and appointments, and helps provide structure throughout the patient&#8217;s life given the dynamic nature of the schizoaffective disorder. Supportive group programs can also help if the patient has been in social isolation and provides a sense of shared experiences among participants.<\/p>\n<h4>Electroconvulsive Therapy<\/h4>\n<div id=\"attachment_4225\" style=\"width: 282px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4225\" class=\"wp-image-4225\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/07020824\/1024px-MECTA_spECTrum_ECT-300x228.jpg\" alt=\"A modern ECT machine in a hospital. It's white and rectangular with numerous knobs and controls as well as a small screen. Wires are plugged into it.\" width=\"272\" height=\"207\" \/><\/p>\n<p id=\"caption-attachment-4225\" class=\"wp-caption-text\"><strong>Figure 3.<\/strong>\u00a0 A modern ECT machine.<\/p>\n<\/div>\n<p>Electroconvulsive therapy (ECT) is usually a last resort treatment. ECT is typically administered by a psychiatrist, an anesthesiologist, and a nurse, as it consists of electrical stimulation to the brain while the patient is under anesthesia. However, not only has ECT been used in urgent cases and treatment resistance, but it should also merit consideration in augmentation of current pharmacotherapy. The most common indicated symptoms are catatonia and aggression. ECT is safe and effective for most chronically hospitalized patients.<\/p>\n<h4>Prognosis<\/h4>\n<p>Given that the diagnostic criteria of schizoaffective disorder change periodically, prognostic studies have been challenging to conduct. However, a study by Harrison et al., 2001 on the overall prognosis of those with psychotic illness showed that 50% of cases showed favorable outcomes.<a class=\"footnote\" title=\"Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube KC, Ganev K, Giel R, an der Heiden W, Holmberg SK, Janca A, Lee PW, Le\u00f3n CA, Malhotra S, Marsella AJ, Nakane Y, Sartorius N, Shen Y, Skoda C, Thara R, Tsirkin SJ, Varma VK, Walsh D, Wiersma D. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry. 2001 Jun;178:506-17. [PubMed] [Reference list]\" id=\"return-footnote-858-4\" href=\"#footnote-858-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a> This study defined a favorable outcome as minimal or no symptoms, and\/or employment. These outcomes were highly reliant on early initiation of treatment and optimized treatment regimens as described above.<\/p>\n<p>Left untreated, schizoaffective disorder has many ramifications in both social functioning and activities of daily living, including unemployment, isolation, impaired ability to care for self, etc. Untreated mental disorders have more than just social and functional consequences. Some studies show that as many as 5% of people with a psychotic illness will commit suicide over their lifetime.<a class=\"footnote\" title=\"Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. J. Psychopharmacol. (Oxford). 2010 Nov;24(4 Suppl):81-90. [PMC free article] [PubMed] [Reference list]\" id=\"return-footnote-858-5\" href=\"#footnote-858-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a> Research has shown that among all completed suicides, 10% are attributable to those with a psychotic illness.<\/p>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>This video tells the story of Juan, who talks about how he&#8217;s managed his schizoaffective disorder diagnosis through an early treatment program.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=5576196&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=WWItoZNFGwY&amp;video_target=tpm-plugin-nc3i1jqn-WWItoZNFGwY\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/SchizoaffectiveDisorderJuansStory_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;Schizoaffective disorder: Juan&#8217;s Story&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>Key Takeaways: Schizoaffective Disorder<\/h3>\n<p><iframe loading=\"lazy\" title=\"49. Schizoaffective Disorder\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291235872141185668\/embed\" width=\"1088\" height=\"435\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script><\/p>\n<p><a class=\"footnote\" title=\"Hans-Jorg A, Bianca U (2020) Schizoaffective Disorder: A Challenge. J Aging Sci. 8: 221. Doi:10.35248\/2329-8847.20.08.221.\" id=\"return-footnote-858-6\" href=\"#footnote-858-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_e7f478a1-86b8-4528-9e64-e1aba201dbf9\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/e7f478a1-86b8-4528-9e64-e1aba201dbf9?iframe_resize_id=assessment_practice_id_e7f478a1-86b8-4528-9e64-e1aba201dbf9\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>electroconvulsive therapy: <\/strong>last resort treatment which\u00a0involves a brief electrical stimulation of the brain while the patient is under anesthesia<\/p>\n<p><strong>schizoaffective disorder:\u00a0<\/strong>a mental disorder characterized by abnormal thought processes and unstable moods<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-858\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Schizoaffective Disorder . <strong>Authored by<\/strong>: Tom Joshua P. Wy and Abdolreza Saadabadi. <strong>Provided by<\/strong>: StatPearls. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK541012\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK541012\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Schizoaffective Disorder. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder\">https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Ghost delusion. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.pxfuel.com\/en\/search?q=hallucinate\">https:\/\/www.pxfuel.com\/en\/search?q=hallucinate<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><li>Risperidone injection. <strong>Authored by<\/strong>: V1ND3M14TR1X. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Risperdal_Consta_injection_syringe.jpg\">https:\/\/commons.wikimedia.org\/wiki\/File:Risperdal_Consta_injection_syringe.jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>MECTA spECTrum ECT. <strong>Authored by<\/strong>: Soggybread. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/commons.wikimedia.org\/wiki\/File:MECTA_spECTrum_ECT.jpg\">https:\/\/commons.wikimedia.org\/wiki\/File:MECTA_spECTrum_ECT.jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/cc0\">CC0: No Rights Reserved<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>Schizoaffective disorder: Juan&#039;s Story. <strong>Provided by<\/strong>: Northwell Health. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=WWItoZNFGwY\">https:\/\/www.youtube.com\/watch?v=WWItoZNFGwY<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><li>Schizoaffective Disorder?...What is it?. <strong>Provided by<\/strong>: Psych2Go. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=nHsS3Ta2MQo\">https:\/\/www.youtube.com\/watch?v=nHsS3Ta2MQo<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-858-1\">Malaspina D, Owen MJ, Heckers S, Tandon R, Bustillo J, Schultz S, Barch DM, Gaebel W, Gur RE, Tsuang M, Van Os J, Carpenter W (May 2013). \"Schizoaffective disorder in the DSM-5\". <em>Schizophrenia Research<\/em>. 150 (1): 21\u20135. doi:10.1016\/j.schres.2013.04.026. PMID 23707642. S2CID 14770729. <a href=\"#return-footnote-858-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-858-2\">Tandon R, Gaebel W, Barch DM, Bustillo J, Gur RE, Heckers S, Malaspina D, Owen MJ, Schultz S, Tsuang M, Van Os J, Carpenter W. Definition and description of schizophrenia in the DSM-5. Schizophr. Res. 2013 Oct;150(1):3-10. [PubMed] [Reference list] <a href=\"#return-footnote-858-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-858-3\">Cascade E, Kalali AH, Buckley P. Treatment of schizoaffective disorder. Psychiatry (Edgmont). 2009 Mar;6(3):15-7. [PMC free article] [PubMed] [Reference list] <a href=\"#return-footnote-858-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-858-4\">Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube KC, Ganev K, Giel R, an der Heiden W, Holmberg SK, Janca A, Lee PW, Le\u00f3n CA, Malhotra S, Marsella AJ, Nakane Y, Sartorius N, Shen Y, Skoda C, Thara R, Tsirkin SJ, Varma VK, Walsh D, Wiersma D. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry. 2001 Jun;178:506-17. [PubMed] [Reference list] <a href=\"#return-footnote-858-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-858-5\">Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. J. Psychopharmacol. (Oxford). 2010 Nov;24(4 Suppl):81-90. [PMC free article] [PubMed] [Reference list] <a href=\"#return-footnote-858-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-858-6\">Hans-Jorg A, Bianca U (2020) Schizoaffective Disorder: A Challenge. J Aging Sci. 8: 221. Doi:10.35248\/2329-8847.20.08.221. <a href=\"#return-footnote-858-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":7,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Schizoaffective Disorder \",\"author\":\"Tom Joshua P. Wy and Abdolreza Saadabadi\",\"organization\":\"StatPearls\",\"url\":\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK541012\/\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Schizoaffective Disorder\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Ghost delusion\",\"author\":\"\",\"organization\":\"\",\"url\":\"https:\/\/www.pxfuel.com\/en\/search?q=hallucinate\",\"project\":\"\",\"license\":\"pd\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Risperidone injection\",\"author\":\"V1ND3M14TR1X\",\"organization\":\"\",\"url\":\"https:\/\/commons.wikimedia.org\/wiki\/File:Risperdal_Consta_injection_syringe.jpg\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"MECTA spECTrum ECT\",\"author\":\"Soggybread\",\"organization\":\"\",\"url\":\"https:\/\/commons.wikimedia.org\/wiki\/File:MECTA_spECTrum_ECT.jpg\",\"project\":\"\",\"license\":\"cc0\",\"license_terms\":\"\"},{\"type\":\"copyrighted_video\",\"description\":\"Schizoaffective disorder: Juan\\'s Story\",\"author\":\"\",\"organization\":\"Northwell Health\",\"url\":\"https:\/\/www.youtube.com\/watch?v=WWItoZNFGwY\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"copyrighted_video\",\"description\":\"Schizoaffective Disorder?...What is it?\",\"author\":\"\",\"organization\":\"Psych2Go\",\"url\":\"https:\/\/www.youtube.com\/watch?v=nHsS3Ta2MQo\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"}]","CANDELA_OUTCOMES_GUID":"d803c586-f4e2-4612-8505-067e2dffae5c, a35cde36-9a4d-40db-b119-aa093b1a82db","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-858","chapter","type-chapter","status-publish","hentry"],"part":152,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/858","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":36,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/858\/revisions"}],"predecessor-version":[{"id":7535,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/858\/revisions\/7535"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/parts\/152"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/858\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/media?parent=858"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapter-type?post=858"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/contributor?post=858"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/license?post=858"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}