New developments in the pharmacologic treatment of schizoaffective disorder.

BACKGROUND: Schizoaffective disorder is a common, chronic, and frequently disabling psychiatric disorder. However, the pharmacologic treatment of this disorder has not been well studied.
METHOD: The authors reviewed the available literature regarding the acute and prophylactic pharmacologic treatment of schizoaffective disorder
RESULTS: Fourteen controlled studies, and only 10 using modern criteria to define the disorder, reported on the efficacy of typical antipsychotics, thymoleptics, or the combination in the acute treatment of schizoaffective disorder. In acute treatment studies of schizoaffective disorder, bipolar type (manic), typical antipsychotics and lithium were comparable in efficacy except in agitated patients for whom antipsychotics were superior. The combination of lithium and antipsychotics appeared to be superior to antipsychotics alone in this patient subtype. In the only controlled study of the acute treatment of schizoaffective disorder, depressive type, combined treatment with antipsychotics and antidepressants was not superior to treatment with antipsychotics alone.
CONCLUSION: Although combination treatment with antipsychotics and thymoleptics is common practice in the prophylactic management of schizoaffective disorder, the efficacy of this strategy has not been studied in controlled trials. Recent preliminary data from open trials suggest that the mood stabilizers valproate and carbamazepine and the novel antipsychotics clozapine and risperidone may be promising new treatments for schizoaffective disorder. Evidence implicating 5-HT2 receptor blockade as an important mechanism underlying possible thymoleptic activity for clozapine and risperidone is also reviewed.