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Schizoaffective Disorder
A Patient & Family Guide
by
 Guenevere MacDonald

Earth Harmony Living

Schizoaffective Disorder: A Patient & Family Guide

By Guenevere MacDonald
Editor Bethan Rickard-Wood
Published by Earth Harmony Living
Copyright 2021 All rights reserved.
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2. Edition, 2021
© All rights reserved.
Earth Harmony Living
ISBN 9798574577028

Dedicated to
My Husband for all his years of support, encouragement, and love.

To my Two daughters who love Unconditionally.

To my Editor Bethany Rickard-Wood for her support and patience.

To the girls, Andrea, Mary Ellen, Shanna, Christine, and Rosemary

for always being there when I need you and even when I think I
don't.

Contents
Preface
Chapter One: For Patients
Chapter Two: The components
Chapter Three: Schizoaffective Disorder
Chapter Four: What it is like.
Chapter Five: Medication
Chapter Six: Additional Treatment
Chapter Seven: Co-morbid Disorders
Chapter Eight: Hospitalization
Chapter Nine: The Importance of Self Care
Chapter Ten: Relapse Prevention
Chapter Eleven: Crisis Planning
Chapter Twelve: Family Support
Chapter Thirteen: Suicide Prevention
Chapter Fourteen: Patients Speak
Chapter Fifteen Stigmas & Stereotypes
Epilogue
"Never, Never, Never Quit."

Winston Churchill
 Preface

I am not a doctor. This book was not written, edited, or in any way produced by doctors. It should

not be used in place of a doctor's advice, diagnosis, or treatment. This book is intended for
educational purposes to help you ask questions and be an active part of your medical treatment.

This book was written because I am a patient. When I received my diagnosis, I found it

increasingly frustrating trying to wade through bits and pieces of information spread out over the
internet, the odd paragraph in a book, and incomplete videos, about schizoaffective disorder.

Any diagnosis is scary in the beginning. It is knowledge that is power, and that knowledge comes

from education. This book aims to provide enough knowledge in one place that patients and their

families can educate themselves enough about their diagnosis. With that knowledge, I hope that they

will actively participate in their medical and self-care therapies. It is also essential that patients ask

questions regarding medications, treatment, and support that may or may not be in place. I hope that
the information gathered here will help you do both and have an active role in your care.
 Chapter One: For Patients

The first time I heard the term Schizoaffective Disorder, I was exiting my
doctor's office. I turned to ask him what it was he thought was wrong with
me, as I was sure it was much more than bipolar disorder, which my
previous doctors had seemed convinced that I had. He told me no, it was not
bipolar disorder but rather Schizoaffective Disorder Bipolar type. I had no
idea what it was, but it scared me. He briefly described it to me, but it did
nothing to help my sense of dread. I spent the hour-long drive home
googling the disorder while my Husband tried to calm my nerves.

I found bits and pieces of information here and there, most of which were
medical research papers, and all pretty much left my need for knowledge
incomplete. I did find endless references to the components of
Schizoaffective Disorder. I found articles listing it as a subtype of
Schizophrenia, and I was surprised to learn that there was a schizophrenia
spectrum, much like the autism spectrum.

It all seemed overly complex, exceedingly rare, and very overwhelming.

As time went on, I gathered as much information as I could from my doctor
and the research I could do when my condition permitted it. The more
pieces I found, the more frustrated I became that no one source adequately
defined the disorder, its symptoms, or its treatment from a patient's
perspective.

Doctors have written most articles for doctors or individuals with a

certain level of psychological knowledge. Few items were written for the
average person, and those that were were woefully incomplete. I found a
few books written by patients detailing their individual experience but none
of the articles or books I found were written specifically to address patients'
needs directly from a patient's level. Fewer still, directed information to
family or caregivers, I set myself a goal to change this.

The initial explanation I received was as follows: Schizoaffective

Disorder is a mental disorder in which a person experiences a combination
of schizophrenic symptoms amid mood disorder symptoms. The name's
breakdown is as follows: Schizo meaning split mind (or break as in a break
from one's mind or reality) and affective disorder, the mood aspect of the
disorder. This is either Bipolar Type or Depressive Type.

The main feature that distinguishes schizoaffective disorder from

schizophrenia disorder is the mood disorder that accompanies it. These are
present a reasonable amount of time but not all the time.

Schizophrenia and schizoaffective disorder are difficult to tell apart as

both have mood symptoms, and both have delusions and hallucinations with
psychosis as a risk factor for both diseases. It became evident as I
researched the disorder, to understand Schizoaffective Disorder fully, it is
imperative to understand the underlying conditions and symptoms involved.

Schizophrenia is defined as a mental health disorder that involves

hallucinations, delusions, and disorganized symptoms.

Bipolar is a mood disorder characterized by extreme changes in mood

and includes bouts of Mania and Depression.
 Depression is a mood disorder characterized by severe sadness, despair,
and lack of motivation.

That is the short version, but the reality is that these mental illnesses are
much more complex. By understanding each of the illnesses and the parts
that contribute to schizoaffective disorder can better understand
schizoaffective disorder.

The following guide is written for patients and their families in hopes that
the information provided will help to provide a clearer understanding of the
disorder, its components, treatment options, self-care, recovery, and relapse
prevention and care.
 Chapter Two: The components

Schizoaffective disorder comprises multiple symptoms from three

separate disorders Schizophrenia, Bipolar Disorder, or Depression Disorder.
There are two distinct forms Schizoaffective Disorder Bipolar Type and
Schizoaffective Disorder Depressive Type. This chapter breaks down the
three separate disorders that make up Schizoaffective Disorder and
describes their symptoms, effects, and risk factors.

Schizophrenia: a chronic mental health disorder that is characterized by

a broken sense of reality (hallucinations, delusions, disorganized thinking).
This disorder affects how an individual thinks, feels, and behaves daily.
Schizophrenia is not nearly as common as other disorders (affecting 1% of
the population) but is extremely disabling. The following features
characterize it:
- Classified as a severe brain and behavior disorder
- It affects the thoughts, feelings, and behavior of the afflicted
individual
- Causes trouble distinguishing between reality and fantasy
- Causes trouble expressing and managing normal emotions and
making decisions
- Causes disorganized behavior and thought
- Blunted emotions and motivation
- Hallucinations such as hearing voices, seeing things that are not
present, smelling smells that are not present, or the sense of being
touched or watched by unseen objects or persons
- Delusions of grandeur
- Paranoid thoughts of mind-reading inserted thoughts or mind control
- Extreme paranoia or suspicion of others
- Symptoms may be continuous or intermittent
- Not multiple personality disorder
- Pose a minor threat to others, and the most significant threat is to
themselves
- The disorder is highly stigmatized
- Can cause agitation or withdrawal from daily life
- Attempt suicide more than the general population
- 10% commit suicide in the first ten years after onset
- A chronic but treatable disorder
- Treated with medication, psychological therapy, social therapy
 A person's risk factors for developing Schizophrenia are based on
genetics, environment, brain chemistry, brain structure, and brain
development.

Several subtypes were once classified as Schizophrenia. These are no

longer in use but something that we should be aware of. Schizoaffective
has since been classified as its own disorder, but there is a good amount of
argument over this. The schizophrenia subtypes are as follows:

Paranoid: feelings of being watched, controlled, or otherwise threatened.

Patients experience extreme suspiciousness, paranoia, and grandiosity, or a
combination of all of these.

Disorganized: incoherent thoughts but not delusional

Catatonic: characterized by mutism, withdrawal, negative effect,

isolation, and impaired physical movement.

Residual: delusions and hallucination symptoms fade away, but lack of

motivation or interest in life and activities is gone.

Schizoaffective: symptoms of both Schizophrenia and a significant mood

disorder characterized by two types Bipolar Disorder or Depression.

Symptoms of Schizophrenia (and Schizoaffective Disorder) can be both

positive and negative.

Positive Symptom: a symptom that is added and not usually present.

Examples include Hallucinations, delusions, or thought disorder. Delusions
themselves can consist of monitoring, threatening, or reading thought-like
beliefs, while hallucinations including hearing, seeing, feeling, tasting, and
smelling things that are not present. Other positive symptoms include
problems with speech, clumsiness, unusual mannerisms, repetitive actions,
motionless rigidity (catatonia)

Negative Symptom: A symptom taken away when usually present, such

as losing motivation to do things. Other negative symptoms can include loss
of functioning emotions, motivation, loss of ability to make plans, speaking
or expressing oneself with emotion, finding pleasure in life, emotional
flatness, lack of expression, diminished capacity to begin and sustaining a
planned activity, social withdrawal and apathy. Negative symptoms can
often be mistaken for a case of depression.

Cognitive symptoms may also become impaired, and this is evident in

attention issues and memory issues. This is one of the most disabling
features for patients looking to lead an everyday life.

Schizophrenia affects individuals ages 16 to 30 years of age. While it can

be diagnosed later, it is seldom diagnosed after age 45 (as a new illness, this
does not include a history of misdiagnosis).

Early Symptoms:
- Diagnosis of Obsessive-Compulsive Disorder
- Depression
- Changes in social behavior, especially withdrawal
- Changes in sleep and eating patterns
- Suspicions or feelings that people are talking about them
- Changes in self-care
- Changes in school or work performance
 - Lack of energy
- Headaches or feelings of strange sensations in the head
- Changes to relationships with family, friends, and coworkers
- Confused, strange, or bizarre thinking

There is no cure for Schizophrenia, but it can be treated and managed.

The second component of Schizoaffective Disorder is the affective

portion, including either Bipolar Disorder or Depression.

Bipolar Disorder
Formally called Manic Depression, Bipolar Disorder causes extreme
mood swings characterized as Mania/Hypomania or Depression. These
mood swings can be categorized as euphoria (mania), a feeling of total
energy or extreme irritability which affects sleep, activities, judgment,
behavior, and ability to think clearly.

Bipolar I
Characterized by one manic episode preceded or followed by a
hypomanic or depressive episode. Mania may cause psychosis (break from
reality hallucinations and or delusions)

Bipolar II
At least one major depressive episode and one hypomanic episode but
never having had a manic episode. It is not a milder form but a different
diagnosis that can have spells of depression for more extended periods,
causing impairment.

Cyclothymic Disorder
 Diagnosed after two years with repeat periods of hypomania symptoms
and periods of depression.

Other types of Bipolar Disorder

Induced by drugs, alcohol, or medical condition

Bipolar disorder is typically diagnosed in teens to early '20s but can occur
at any age.

Mania and Hypomania (3 or more symptoms present):

- Abnormally happy, wired, jumpy active, hyper
- Increased energy, activity, irritability, agitation
- An exaggerated sense of self-confidence and well being
- Decreased need for sleep
- Unusual talkativeness or rapid speech
- Racing thoughts
- Distractibility
- Poor decision making, spending sprees, promiscuity, sexual risks,
foolish investments

Major Depression episodes include five or more of the following

symptoms that are severe enough to interfere with everyday activities,
work, and school.
Decreased mood, feeling sad, empty, hopeless, or tearful and irritable
- Marked loss of interest or feeling no pleasure at all or almost all
activities:
- Significant weight loss while not dieting
- Weight gain or loss with decrease or increase in appetite
- Restlessness or slowed behaviors
 - Insomnia or sleeping too much
- A feeling of worthlessness or excessive or inappropriate guilt
- Decreased ability to think or concentrate or indecisiveness
- Thinking about planning or attempting suicide

Other Features of Bipolar Disorder

- Anxiety and distress
- Melancholy
- Psychosis
- Mixed or rapid cycling
- Symptoms that occur in cycles or with the change of seasons

People with Bipolar seldom recognize their symptoms at the time or the
severity of disruption in their lives and family and friends. When symptoms
of mania or depression arise, it is advised that individuals speak to their
doctors so their symptoms can be brought under control. A medication
adjustment usually does this. Emergency help should always be sought if
thoughts of suicide or suicide attempts occur.

Causes of Bipolar Disorder

Biological: physical changes in the brain occur in individuals with this

disorder, but these changes' significance is unknown.

Genetics: the disorder is more common in those with a close relative like
a parent, grandparent, or sibling with the disorder.
 Environment: environmental factors while in utero or at the time of birth
may also play a role in the disorder.

Risk Factors

- Having a family member with Bipolar Disorder

- Periods of high levels of stress or traumatic event
- Drug or alcohol abuse

If Left Untreated individuals are at higher risk of

- Drug and alcohol abuse
- Suicide or suicide attempts
- Legal and financial problems
- Relationship issues
- Poor work or school performance
- Loss of employment, drop out of school
Co-Occurring conditions can also affect how Bipolar affects an individual:
- Anxiety disorders
- Eating disorders
- ADHD
- Obsessive-Compulsive Disorder
- Alcohol and or Drug addictions
- Physical health issues
- Obesity

Depression
We all have those moments in life when we feel blue or down, and while
we may describe this as being depressed, it does not fit the clinical criteria
for real depression. Real depression is not categorized as brief periods of
grief, sadness, or even the blues but rather as darker despair. Most people
who suffer from depression describe it as an ongoing mood of sorrow and
pain. Some describe it as the worst pain they have ever felt.
Depression is believed to have several causes, which include:

Family History: depression is more prominent where a close family

relative also suffers from depression.

Recent Events: trauma, divorce, death, loss of employment, life changes,

and stress are all known to trigger depressive episodes

History: common in individuals with a history of child abuse, abuse,

trauma, neglect, and abandonment. Recent or past abuse, violence, witness,
or victim of violence.

Depressive thoughts and behaviors carry an unfavorable view.

 Typical Behaviors include:

- Low mood, despair, sadness, anxiety, numbness

- Can cause social withdrawal
- Self-medicating with drugs and alcohol (40% abuse alcohol)
- Neglect self-care, no showers, do not eat properly or care for living
space

All these combined can lead to depression. There is no set medical test
for a depressive episode diagnosis. Instead, it is based on five of these
symptoms for two weeks or more.

- Sleeping too little or too much

- Having gained or lost significant weight without dieting
- Highly emotional and agitated
- Sluggish and or inert
- Unexplained aches and pains
- Loss of interest in hobbies and past times
- Unable to concentrate and or make decisions
- Negative anxious trapped unable to act
- Despair, feeling guilty over everything
- Fatigue and overall loss of energy
- Suicidal (thoughts or attempts)
- Numb, a feeling of emptiness

Types of Depression

Major Depressive Disorder

 Five or more symptoms for two weeks or longer and have a significant
change in your ability to function

Some may experience psychosis where their thinking is disordered and

out of touch with reality
Can become focused on thoughts and plans of suicide. May extend those
thoughts to loved ones.

It May occur once and never have a repeat episode, or it may become
recurrent.

Dysthymic Disorder

Dysthymic is a term for a form of depression. People experience low

moods for a long time, still functional, but experience long-term symptoms
and have major depressive episodes.

Postpartum Depression

Postpartum depression is a depressive episode(s) that occurs after the

baby's delivery. This can evolve to Postpartum Psychosis and should be
treated and monitored right away.

Other types of depression include Treatment-resistant depression,

substance abuse-related depression, and depression related to post-traumatic
stress disorder.

Depression and Physical Pain

There are shared neural pathways for pain and depression. Serotonin and
norepinephrine are involved in mood and pain reception, and the higher the
physical symptoms, the greater the chance of depression. Depression is
also believed to increase the level of sensitivity to pain, and the return of
pain symptoms can be an indicator of a potential relapse of depression
symptoms. Individuals with pain symptoms as well as depression are at a
higher risk of suicide.

Treatment options for depression include:

- Medication
- ECT (electroconvulsive therapy)
- Psychotherapy, including family, personal, marital, and group
- Cognitive Behavior Therapy
- Psychoeducation
- Self-education/management
- Peer Support/ Self Help
 Chapter Three: Schizoaffective
Disorder

So, what exactly is schizoaffective disorder? Once thought to be a

subtype of Schizophrenia, it is now diagnosed as a separate disorder and has
been since the publication of DSM III. In a nutshell, someone with
schizoaffective disorder will have all the main components of
Schizophrenia and also suffer from either bipolar disorder or major
depressive disorder. However, that is not the best description of the
condition.

The DSMV, which is the current authority on diagnosis in North

America, defines Schizoaffective Disorder as follows:

Meeting the primary criteria for Schizophrenia which would include two or
more of the following symptoms:
- Delusions
- Hallucinations
- Disorganized speech (speech that incoherent or easily distracted)
- Grossly disorganized or catatonic behavior
- Negative symptoms (flat expressions, loss of pleasure, lack of
motivation, and other experiences that are taken away from the
person)
 Schizoaffective disorder must also include these symptoms:
- A significant mood episode (either depressive or manic) that lasts for
an uninterrupted period
- Delusions or hallucinations for two or more consecutive weeks
without mood symptoms sometime during the life of the illness
- Mood Symptoms are present for much of the illness
- The symptoms are not caused by substance use

Schizoaffective Disorder, Schizophrenia, and bipolar disorder are

difficult to distinguish between as all three can have symptoms of:
- Feelings of elation or highs for a period
- Rapid speech
- Racing thoughts
- Bizarre behavior
- Risk-taking behaviors
- Agitation
- Grandiose delusions
- Hallucinations

While schizophrenia and schizoaffective disorder look very much alike,

they are not the same disorder. Schizoaffective disorder differs from
Schizophrenia because of several characteristics that are present in
schizoaffective disorder but not Schizophrenia. These include:
Mood symptoms are present for most of the illness;
- Social dysfunction is not as severe in schizoaffective disorder as it is
in Schizophrenia
- Negative symptoms such as lack of motivation and self-care are not
as severe
 - It's possible to have autism spectrum disorder or other developmental
disorder starting in childhood if you have schizoaffective disorder,
not so with Schizophrenia
- Schizoaffective disorder is a psychotic disorder with significant
mood disorder features
- The disorder is individualized with mixed outcomes relating to both
the psychotic symptoms and the mood disorder

Schizoaffective disorder is considered a profoundly severe mental health

disorder and has been known to affect women more than men, whereas
Schizophrenia is more dominant in men than women. Men also tend to have
an earlier onset of both disorders.

Depending on the age of onset and various factors, patients can have
better or worse predicted outcomes.

Some characteristics associated with predictions of better outcomes

include:
- They are considered to have relatively "normal" behavior and
personality before onset. This includes easily making friends, no
delinquency, good grades in school, reasonable intelligence, etc.
- Women have a more favorable outcome than men
- Those without a family history of schizoaffective Disorder or
Schizophrenia tend to do better
- A family history of depression or bipolar disorder
- Older age at onset
- Sudden onset
- Paranoia or catatonia
- Presence of normal feelings
 - Good awareness of the illness
- Normal CT or MRI
- Good Initial response to medication.

Poorer outcomes are associated with:

- Problems in childhood, strange behavior, poor school performance,
delayed milestones, issues with friends, withdrawn
- Men are less likely to have a favorable outcome than women
- A family history of schizoaffective Disorder or Schizophrenia
- Younger age at onset
- Slow onset
- Predominately negative symptoms
- Flattening effect of emotions
- Poor awareness of the illness
- Abnormal CT or MRI
- Inadequate initial response to Medications.

Men are more likely to develop Schizophrenia, whereas women are more
likely to develop schizoaffective disorder. Development later in life tends to
be associated with Depressive type and has a better outcome. Development
at an earlier age is more associated with Bipolar type and a worse outcome.

Some believe that schizoaffective disorder is more towards the middle of

the schizophrenia spectrum. It is a subtype of Schizophrenia, while others,
including the DSM V, consider it an illness independent on its own. Prior to
DSM III, Schizoaffective Disorder was defined as a subtype of
Schizophrenia.
 Chapter Four: What it is like.

For patients with schizoaffective disorder, their symptoms may be like

others, or they may differ vastly. No two patients will have the same
symptoms, making treatment more complex as it must be specially designed
for the individual, not for the illness. However, while the severity of
symptoms and the types of symptoms may vary from patient to patient, the
specific circumstances of symptoms are similar.

Descriptions of delusions and hallucinations often have a similar theme,

while disorientation, lack of motivation, depression, despair, and mania all
reflect similar characteristics even if under different circumstances. The
feeling of euphoria can be the same in two other individuals even though
they are experiencing different aspects of mania, such as increased activity
with little sleep versus additive or risk-taking behaviors (i.e., gambling,
promiscuity, or drug and alcohol use).

Those experiencing auditory hallucinations can report voices in their

head and their outside environment—some report both, some report only
one or the other. Auditory hallucinations can be everything from demeaning
foul language and name-calling to narrative speaking, screaming, and
background crowd noise. Patients will often describe similar types of
hallucinations, but no two will be identical. For example, I have had a
narrative voice that comments on everything I do, yet I have spoken to
another patient who had a narrative voice that commented on everything
others around him did. Some have only background crowd noise, while
others never experience it. Everyone's experience with the disorder is
unique.

Trying to function and perform day-to-day tasks while constantly being

disrupted by these hallucinations can be maddening. Imagine trying to read
a book while there is a constant hum of talking in the background or
random screaming. Imagine the frustration and anxiety of entering the
bathroom while voices in your head scream you are fat and ugly. Imagine
sitting still in a business meeting with the sensation of bugs crawling up and
down your arms, across your face, or through your hair. Then explain your
reaction to these events to individuals observing you.

Other hallucinations can be more disturbing and leave individuals badly

shaken or frightened. One hallucination I experienced left me so severely
frightened I have refused to travel the same walking path since. On that
occasion, I saw a man running towards me. At first, it did not seem like
anything out of the ordinary, just a man running up the road. As he
approached, I realized he was running full speed directly at me. His face
was distorted, and he let out a horrifying scream. When I attempted to turn
and run, I fell. I managed to get to my feet and take several steps before
looking over my shoulder, only to discover the man was gone. I was so
scared by what I saw I could not react, and I stood standing in the road
looking around in every direction expecting him to come back at me. He
did not. I made my way home, crying and shaking, looking over my
shoulder the whole way. I knew at that point that it had been a
hallucination, but it did not calm me in any way. The man I saw may not
have been real, but the emotions, the fear I felt was genuine, and it took
several days to calm down from the event.

For those suffering from the Bipolar type of Schizoaffective Disorder,

mania can be as crippling as depression. Its effects are more problematic for
the individual after the mania has passed. During mania, individuals might
go days, if not weeks, with little to no sleep while actively exhibiting
hyperactive and energized activity. My record is 16 days on less than 6
hours of sleep. I was buzzing around the house, starting and stopping
projects at random. I organized and reorganized the entire house seven
times in one week.

While mania can sometimes lead to productive activities, lack of sleep

and mania can cause poor judgment and little to no filter. This often results
in strains in relationships, financial, legal, and social problems. Individuals
have been known to make inappropriate comments in private and public
settings, frequently divulging family secrets, rude remarks, and opinions
that should otherwise be kept quiet.

Excessive spending can result in missed mortgage and loan payments,

lack of groceries or medications, loss of insurance, disconnection of
utilities, etc. It can strain relationships as loved ones often do not
understand this as being a symptom of mania.

Poor judgment can also lead to relations outside of marriage, excessive

gambling, or drug use. Lack of insight and judgment can also lead to
reckless and suicidal behavior.

Extensive bouts of mania can lead to hallucinations and delusional

thinking resulting in acute psychosis. Patients are not aware of their
behavior and are often embarrassed and ashamed when they learn of their
actions after the fact. Adding insult to injury, manic episodes are followed
by depressive episodes, heightening the sense of embarrassment, shame,
and self-loathing.

Depressive episodes for some can mean lack of motivation, increased

severe boredom, and loss of interest. Some describe persistent feelings of
low spirits, sadness, irritability, rage, and withdrawal, while others can be in
complete despair. The severity and the type of experience will differ, but the
main characteristics of the disorder remain.

In addition to the varying degrees of experiences, describing symptoms

such as a depressive episode to someone who has not experienced it is not
easy. Sometimes, it is just a feeling of dragging and extreme boredom about
everything around you. Other times, it is accompanied by unexplainable
bouts of crying, rage, and irritability.
I once experienced an episode where the emotions were so intense; I
could only describe them as a combination of having someone jump out and
scare me while simultaneously losing a family member and having one
hand tied behind my back trying to do a difficult task. Smother all that in
intense, overwhelming withdrawal. Everything caused anxiety, made me
cry and rage at the same time. The mere attempt to describe it is exhausting
and falls dreadfully short of the experience. The episode was so intense I
found myself in actual physical pain. The emotions were raw and ranged
from anxiety to irritability, sadness, fear, despair, lethargy, frustration, pain,
and self-loathing. I had a million things I needed to do, dozens of things I
wanted to do, but the critical element in getting myself up and motivated,
getting my emotions in check, was completely missing.
 While some can function and wade their way through a major depressive
episode, others may find themselves crippled by a mild attack. Neither is
better or worse than the other, as we all experience our emotions on
different levels when confronted with different circumstances. The point is
both individuals are suffering and need support.

Another acute symptom that affects many is disorganized thinking. This

can make it impossible to perform simple tasks, complete a project, perform
well at school or work. Adding a mood disorder (either mania or
depression) or hallucinations to disorganized thinking, and you have a pile
of mess that is not only unbearably difficult to maneuver through but also
near impossible to describe to friends and loved ones. It creates intense
levels of frustration and anger.

The following article was shared by a member of the

Schizophrenia/Schizoaffective Disorder Facebook Support page. The
article's author is unknown, but it adequately describes how a simple task
can become overwhelming when the disorder is in full swing. The message
is an empowering one for those who suffer from this disorder.
When I was at one of my lowest (mental) points in life, I couldn't get out
of bed some days. I had no energy or motivation and was barely getting by.
I had therapy once per week, and on this particular week, I didn't have
much to 'bring' to the session. He asked how my week was, and I really had
nothing to say.
"What are you struggling with?" he asked.
I gestured around me and said "I dunno man. Life."
Not satisfied with my answer, he said "No, what exactly are you worried
about right now? What feels overwhelming? When you go home after this
session, what issue will be staring at you?"
 I knew the answer, but it was so ridiculous that I didn't want to say it.
I wanted to have something more substantial.
Something more profound.
But I didn't.
So I told him, "Honestly? The dishes. It's stupid, I know, but the more I
look at them the more I CAN'T do them because I'll have to scrub them
before I put them in the dishwasher, because the dishwasher sucks, and I
just can't stand and scrub the dishes."
I felt like an idiot even saying it.
What kind of grown ass woman is undone by a stack of dishes? There are
people out there with *actual* problems, and I'm whining to my therapist
about dishes?
But my therapist nodded in understanding and then said:
"RUN THE DISHWASHER TWICE."
I began to tell him that you're not supposed to, but he stopped me.
"Why the hell aren't you supposed to? If you don't want to scrub the
dishes and your dishwasher sucks, run it twice. Run it three times, who
cares?! Rules do not exist, so stop giving yourself rules."
It blew my mind in a way that I don't think I can properly express.
That day, I went home and tossed my smelly dishes haphazardly into the
dishwasher and ran it three times.
I felt like I had conquered a dragon.
The next day, I took a shower lying down.
A few days later, I folded my laundry and put them wherever the heck
they fit.
There were no longer arbitrary rules I had to follow, and it gave me the
freedom to make accomplishments again.
 Now that I'm in a healthier place, I rinse off my dishes and put them in
the dishwasher properly. I shower standing up. I sort my laundry.
But at a time when living was a struggle instead of a blessing, I learned
an incredibly important lesson:
THERE ARE NO RULES.
RUN THE DISHWASHER TWICE!!!

The following is a descriptive list from actual patients describing their

experiences with schizoaffective disorder:

- Horrid, my body hurts every day, and I feel strange and detached
- Confusing, I cannot tell if my memories are real or made up
- I feel like everyone is out to get me
- Random weird tastes
- Moods change so quickly my head spins
- Dazed and confused
- Feels like hell
- My brain feels like it is on fire
- Scared and confused all the time
- Exhausting. Stress, anger, fear, deluded ideas, everything is unreal
and dreamlike. Nightmarish, fear isolation, and undesirable
- Burnout
- Amplified anxiety
- Exhaustion all the time
- Easily triggered
- Emotionally overwhelmed
- Insomnia from hell
- Little to no motivation all the time, I cannot function
- Tired of fighting an invisible enemy
 - Paranoia to the extreme
- Taken advantage of
- Like I'm on a tv show
- What is it like to be normal, don't deserve to be better, feel deformed,
deserve to be miserable feeling watched all the time
- Endless intrusive thoughts
- Isolated
- Brain fog, zombie-like
- Severe anxiety
- Self-loathing, I hate myself
- Just pain, endless pain
- My life has been kidnapped.

Many individuals report the most about this illness: the constant
gaslighting and stereotypical reactions of those they were close to. Often,
relationships deteriorate due to untold pressure of being expected to fit the
public's standard behavior patterns. Patients are often told to stop playing
the victim to go for a walk, take some herbs, drink some fantastic teas, or
grow up and behave like a "normal" human being.

The reality of mental health conditions is that they are no different from
any other human body aliment. It is a part of the body that is
malfunctioning and failing to operate in its usual manner. Yet, for many
patients, the frustration is overwhelming. It would be another story if family
and friends considered the patient as suffering from another organ problem.
One comparison that can be drawn is that of diabetes and schizoaffective
disorder.
 One is a disease of the pancreas and its failure to produce enough or
overproduce insulin. Like the pancreas in diabetes, the brain n
schizoaffective disorder does not have adequate dopamine and serotonin
levels. Yet, the reaction to the two diseases is entirely different. You would
not tell a person with diabetes to stop playing the victim or go for a walk,
and they will feel better or try some magical tea to cure them. These
statements would never be made to a cancer patient, someone with MS or
Alzheimer's, yet they are repeatedly spoken to mental health patients.

Mental illness is a genuine illness, and its victims are actual victims.

Stereotyping, manipulation, and discrimination are genuine and regular

parts of mental illness.
 Chapter Five: Medication

The first and most effective treatment for Schizoaffective Disorder is

medication. A medication regimen usually consists of an antipsychotic, a
mood stabilizer, and sometimes an antidepressant. Additional medications
may be added to assist with sleep problems, tremors, anxiety, and various
side effects. The effectiveness of any medication regimen is adherence. It
may take several trials of different medications to find the proper dosage
and combination, so it is essential to follow through until the right
medication is found. Once a medication regimen is in place, it is crucial to
stick to it and report any side effects and unwanted symptoms to your
doctor so that medication can be adjusted for optimum effectiveness.
Quitting medicine suddenly can cause severe withdrawal symptoms and
adverse effects, so it is highly discouraged.

Antipsychotics
Antipsychotic drugs used to control and prevent psychotic symptoms
have been in use since the 1950s with the introduction of 1st generation or
typical antipsychotics. 2nd generation or atypical antipsychotics made their
appearance in the 1970s. Both are still in use today, although 2nd generation
is used more commonly than 1st generation as they have fewer movement
disorder side effects. The most effective atypical antipsychotic for
Schizophrenia and schizoaffective disorder is believed to be Clozapine;
however, it is not the most prescribed as it can cause drops in white blood
cell counts and requires constant monitoring. It is usually only prescribed
when at least two other antipsychotic drugs have been used and failed.

Antipsychotics work by reducing and balancing the brain chemical

known as dopamine. Dopamine is one of several brain chemicals that assist
in carrying messages to and from various points of the brain. It is believed
that too much dopamine or an imbalance of dopamine in conjunction with
other brain chemicals can cause the brain to react adversely, causing
symptoms of psychosis. By reducing and balancing dopamine levels,
antipsychotics can effectively stop psychotic symptoms and prevent
relapses from occurring. It is believed that some 2nd generation
antipsychotics also work on serotonin levels.

Antipsychotics effectively suppress and control psychotic symptoms such

as hallucinations, delusions, paranoia, and disorganized thought process.
They are used to treat psychotic episodes in Schizophrenia, schizoaffective
Disorder, and Bipolar Disorder
as well as PTSD, OCD, Personality Disorders, Tourette's syndrome and
some cases of autism.

By treating and preventing psychotic symptoms, antipsychotics increase

life quality and more effective secondary treatment options such as
Cognitive Behavioral Therapy.

More common typical (1st generation) antipsychotics include Thorazine,

Haldol, and Triladon. More common atypical (2nd generation)
antipsychotics include Abilify, Vraylar, Latuda, Seroquel, Risperdal
Geodon, and Clozapine.
 Like all medications, there are side effects for antipsychotics, and it is
often the side effects that lead to individuals discontinuing the drug. Most
side effects are mild and subside over time, while others may require
additional medication to control them. Any side effects should be discussed
with your doctor.

Some common side effects related to most antipsychotics (but not all)
include:
- Sedation
- Headaches
- Dizziness
- Diarrhea
- Anxiety
- Akathisia ( a movement disorder that causes inner restlessness)
- Dystonia (abnormal muscle contractions)
- Tremors
- Drooling
- Lactation
- Swelling of breast tissue
- Sexual dysfunction
- Osteoporosis
- Weight gain
- Blurred vision
- Constipation
- Dry mouth
- Tardive dyskinesia (slow, repetitive movements of the face, lips,
torso, and or legs)
- Diabetes
- Liver disease
 - Kidney disease

Sudden withdrawal from antipsychotic medication can cause serious to

severe withdrawal symptoms. Medication should always be gradually
reduced under the supervision of a doctor before stopping. Withdrawal
symptoms can include:

- Nausea
- Vomiting
- Loss of appetite
- Restlessness
- Excessive sweating
- Insomnia
- Dizziness
- Numbness
- Muscle pain
- Psychosis

Mood Stabilizers
Mood Stabilizers are a psychiatric medication used to treat mood
disorders that cause intense and sustained mood shifts. Examples of these
disorders include bipolar disorder and bipolar type schizoaffective disorder.
The most prescribed mood stabilizers are Lithium and a variety of
anticonvulsants such as Valproate and Lamotrigine. Some antipsychotic
medications such as Risperidone and Quetiapine have mood-stabilizing
effects as well. Mood stabilizers are mainly antimanic agents that prevent
and control mania episodes, rapid mood cycling, and mood shifts. Most
mood stabilizers are ineffective in treating acute depression except for
Lamotrigine, Lithium, Olanzapine, and Quetiapine.

Side effects of mood stabilizers are similar to those of antipsychotics and

also include sensitivity to heat, drowsiness, blurred vision, constipation,
restlessness, agitation, tremors, nausea and vomiting, headaches, and weight
gain. Each medication affects individuals individually, and side effects
usually subside as treatment continues.

Special care for Lithium patients

Lithium, like Clozapine, is a medication that requires special attention. It is
highly effective in treating mood disorders and is commonly prescribed.
However, its effectiveness depends on blood levels, too little, and there is
no effect, too much, and it can cause lithium toxicity. Regular blood level
screenings by blood tests can inform your doctor if you are within the
treatment level of 0.6 to 1.2 milliequivalents per liter. Levels registering
2.0mEQ/L will result in mild to moderate Lithium toxicity, while levels
3.0mEQ/L are cause for a medical emergency.

Lithium Toxicity

Early signs of mild to moderate toxicity include:

- Shakiness in hands
- Thirst
- Increased and frequent urination
- Diarrhea
- Vomiting
- Drowsiness
 - Muscle weakness
- Coordination problems

Severe Toxicity signs

Mild to moderate symptoms listed as well as:

- Giddiness
- Blurred vision
- Ringing in ears
- Severe shakiness
- Seizures
- Heightened reflexes
- Agitation
- Slurred speech
- Kidney failure
- Rapid heartbeat
- Hyperthermia
- Uncontrolled eye movements
- Confusion
- Coma
- Delirium
- Death

Lithium patients suffering from lithium toxicity can sometimes be

confused for being drunk or impaired. It is recommended that if you take
Lithium, that you should wear an identifying piece of jewelry or
accessory such as a medic alert bracelet to avoid this confusion. Doing so
 ensures proper and immediate medical care should police or paramedics
be called.

Antidepressants are sometimes prescribed alongside antipsychotics

and mood stabilizers. While they can be effective for some patients, they
can cause issues for others.

- Antidepressants can, in some cases, induce mania if a mood

stabilizer has not already been prescribed and established.
- Antidepressants are ineffective for treating acute bipolar depression,
preventing relapse and have been reported to cause rapid cycling in
some patients
- Antidepressants have been associated with higher rates of non-lethal,
suicidal behavior in some patients.
- Relapse, rapid cycling, and mixed episodes are more common in
patients taking antidepressants with antipsychotics and mood
stabilizers.

The effectiveness or ineffectiveness of antidepressants depends on the

individual patient and their symptoms and other medications the patient is
taking. It is essential to discuss any medication issues with your
doctor, so they can best decide on the right medication combination for your
specific symptoms.

Medications affect individuals differently, and no two patients will

have the same experience with a particular drug. Side effects can be
problematic for some but are usually short-lived and subside as the dosage
is stabilized. It is important to note that it can take some time to find the
proper medication and dosage, so it is essential not to give up on treatment.
Always inform your doctor of any other medications you may be taking as
antipsychotics can interfere with other drugs. By keeping to a prescribed
regiment, 4 out of 5 patients find a successful treatment of their symptoms
and improve their quality of life.
 Chapter Six: Additional Treatment

There are several treatments for Schizoaffective Disorder. They include

Medication (the primary form of therapy), Psychotherapy, and social
programs.

Psychotherapy is a general term for talking to a psychiatrist or trained

mental health professional about your condition, thoughts, mood, and
behavior.
Psychotherapy works by helping patients understand their illness the
feelings and behavior associated with it to address their challenges.
Psychotherapy is like counseling but delves much more profound and is
more intense.

Psychotherapists can be any one of the following professionals:

- Psychologist
- Psychiatrist
- Marriage or family counselor
- Social worker
- Professional counselor
- Mental Health Counselor
- Psychiatric nurse practitioner
- Psychoanalyst
 Psychotherapists can help with the following aspects of mental health:

- Overwhelming feelings of sadness and depression

- Anxiety
- Work, school performance problems
- Addictions
- Self-harm/harming others
- Feelings of helplessness, worthlessness
- Those who have experienced abuse
- Mental health conditions such as Schizophrenia, schizoaffective
disorder affects daily living.

Types of Psychotherapy

Cognitive Behavioral Therapy (CBT): related to how thoughts and

behaviors affect how patients feel and act. Used to help treat depression,
eating disorders, anxiety, low self-esteem, and post-traumatic stress disorder
(PTSD), as well as Schizoaffective Disorder (SZD).

Interpersonal therapy helps to find new ways to communicate and

express feelings and helps with relationships. Patients learn to understand
and adjust their approach to interpersonal problems and develop ways of
managing these problems.

Psychodynamic therapy: deals with addressing past experiences such as

childhood memories that can impact thoughts and behaviors that patients
are often unaware of their influence.
It helps to identify the source of feelings like distress and anxiety and
develop more control. Psychodynamic therapy is less intense than
psychoanalysis.

Family Therapy: provides a safe space for families to express views,

concerns, and feelings while learning to understand each other.

Group Therapy: usually involves 5 to 15 participants and is often used

for dealing with depression, chronic pain, and substance abuse, to name a
few topics covered. Group therapy usually involves meetings of one to two
hours each week. Individuals may also attend one-on-one treatment with the
therapist outside of the group. Group members are encouraged to help and
support each other.

Online Therapy: a new concept in therapy. It is like other therapies but

helps those with mobility problems, those in rural or smaller communities
that do not have specialist services in their area. It can help relieve schedule
conflicts and anxiety involved in traditional face-to-face communication.
Therapy is done via online video meetings, text, and mobile messenger
services.
Other therapy types that may be used include but are not limited to
animal therapy, art therapy, and play therapy.

Social Programs
Social programs are used to help monitor patients well being. They can
also monitor medication use, family relations, and nutrition plans. Social
programs can include therapy, a mental health nurse, psycho educators, job
placement services and counseling, assistance with housework, and daily
tasks. Social programs are designed to help create a safe, calm environment
for the patient, avoid isolation and allow the patient to be an active
participant in their after-care.
 Chapter Seven: Comorbid Disorders

Several comorbid diseases and disorders accompany or are a direct result

of Schizophrenia and schizoaffective disorder. Three of the most common
are Fibromyalgia, Diabetes, and Obsessive-Compulsive Disorder.

Fibromyalgia
People with Schizophrenia and Schizoaffective patients make up 5% of
fibro patients in the United States while only accounting for 1% of the
population. There is no known cure for Fibromyalgia, and treatment is
through management. Its connection to Schizophrenia and Schizoaffective
Disorder is unknown.

Symptoms

- Constant dull body pain

- Sleep problems
- Cognitive difficulty or brain fog
- Fatigue
- Insomnia (waking up unable to return to sleep)
- Abdominal pain
- Irritable Bowel Syndrome
- Migraines
 - Jaw and facial tenderness
- Sensitivity to lights, sounds, odors, heat, and cold
- Anxiety
- Depression
- Numbness, tingling of the hands and feet
- Irritable bladder
- Reduced tolerance for exercise

Medication used to treat Fibromyalgia is analgesics to relieve pain,

antidepressants for depression and anxiety, and Anti Seizure drugs to reduce
symptoms. Self Care is vital to maintenance and recovery.

Obsessive-Compulsive Disorder
One of the first warning signs of Schizophrenia can be Obsessive
Compulsive Disorder. It is unknown what the connection between the two
disorders is; however, despite both disorders being present in 1% of the
population, OCD is present in 25% of Schizophrenia and schizoaffective
patients.

Obsessive-Compulsive Disorder like Schizophrenia and schizoaffective

disorder is a chronic mental illness that can disrupt employment, personal
relationships, mental health issues and overall, well-being. Obsessive-
Compulsive disorder causes unwanted thoughts, urges, and fears which
become obsessions. These obsessions lead to repetitive behaviors called
compulsions.
Although it can surface in childhood, onset usually occurs during
adolescents and early adulthood. Treatment involves medication and
psychotherapy. Some of the medicines used to treat schizoaffective disorder
are also used to treat Obsessive Compulsive Disorder.
 Symptoms
Obsessive behavior usually centers around a particular theme or belief.
Examples include:
- Order and appearance
- Security
- Danger
- Inappropriate behaviors
- Sexual imagery
- Avoidance behavior

Compulsions like obsessions also tend to center around particular themes

as they are based on obsessive thoughts. Examples:

- Washing and cleaning

- Checking and rechecking
- Counting and pattern repeating
- Orderliness and strict routines
- Demanding reassurances of patterns.

Individuals who have Obsessive Compulsive Disorder will have intrusive

thoughts accompanying their obsessions. Intrusive thoughts can be things
like the house burning down (repeated checking of the stove, heaters, etc.),
thoughts of hurting others (avoidance behavior, staying home and avoiding
certain activities locations or individuals), inappropriate behavior or sexual
imagery (avoidance behaviors) fear of germs or contamination (cleaning,
organizing actions). Control over one's environment (pattern repeating,
routines, counting, reassurance behaviors).

Other illnesses related to Side effects and medications:

- Cardiovascular disease
- Liver disease
- Stroke
- Diabetes
- High blood pressure
- Some cancers
- Sexual dysfunction
- STD's
- Infectious diseases (HIV, TB, Hepatitis)
- Osteoporosis
- Dental Health complications
- Auto immune disorders MS, Fibromyalgia
- Pregnancy complications
- Obesity\ Obesity-related cancers
 Chapter Eight: Hospitalization

No one likes the idea of being hospitalized. Being away from familiar
surroundings, personal effects, and family and friends can be pretty stressful
on their own. Adding symptoms of acute depression and or psychosis can
make for a very scary situation.

Hospitalization is usually a last resort option for many mental health

care professionals. Their goal is to get you well and to keep you well
whenever possible by avoiding hospitalization. However, there are certain
circumstances when the hospital is the best place you can be:
- If you are feeling suicidal/ planning suicide
- If you are experiencing acute psychosis
- If you are experiencing acute depression that puts you at risk of
suicide
- If you are off your medication or need a specific medication change.
- If you are starting Clozapine for the first time
- If you are exhibiting self-harm behaviors or violence toward others
Hospitalization can be voluntary (you commit yourself) or involuntary
(someone else such as family or the court commits you because you pose a
threat to yourself or others). A voluntary commitment can become an
involuntary one if medical professionals believe it is unsafe for you to leave
hospital facilities in many places. While this may seem unfair, it is often the
best thing for you and others.

What you can expect

Depending on your condition and the facility you are admitted to, you
can expect a series of events to occur upon admission.

- Evaluation, usually done within a short time of your arrival. This is

done through observation, interviews, medical tests, etc. If you are
cognitive and aware, a consultation will take place. If you are
symptomatic to the point that you cannot communicate, an interview
will occur later.

- Holding: during and shortly after evaluation, you may be in a

holding area before moving to a more permanent ward or room.
While in the holding area, you will be asked to change clothes and
hand over your personal effects. Depending on your condition and
the facility, these may be returned to you later when deemed safe.
Some facilities will hold your items and provide you with clothing,
hygiene items, etc., for the duration of your stay. While in the
holding area, you may be in isolation where you are closely observed
or in an open area with other patients. This will depend on your
symptoms at the time.

- Once you have been evaluated, you will likely be moved to a more
permanent area such as a shared ward (a room with several patients)
or a room with yourself and another patient.

- Once settled in, the nursing staff will explain the routines, rules,
 regulations, and medical procedures you can expect throughout the
day. If you are highly symptomatic, this will be explained later, and
treatment will take priority.

- You will be assigned a series of medical professionals. Or if your

doctor works at the facility, you will be assigned to him or her.
Medical professionals you can expect to see in a hospital setting
including nursing staff, psychiatrists, social workers, therapists,
psycho-educators, and volunteers.

- You will be expected to participate in your treatment. Depending on

your condition at the time, the level of participation will vary. As
your condition improves, you can expect to participate in interviews
with your team members and various therapies that can include
treatments such as cognitive behavior therapy and psychotherapy and
may even include art, meditative, or music therapy. Each facility has
a different setup for treatment.

- Hospitalization can take a few days to regulate medication to several

weeks or even months to diagnose or stabilize your condition.

- During your stay, doctors will order medication for your condition.
This might be an adjustment to medication you already take or
alternative medicine believed to treat your symptoms better.

- As you progress through your hospitalization, you can expect to gain

more privileges. These may include the opportunity to wear your
own clothing, participate in walks and activities in outdoor areas, and
participate in extracurricular activities such as art sessions.
 - Once you have stabilized, hospital staff will begin working with you
to establish your after-care. This will include things such as
medication and outside resource services that may be available in
your area and necessary therapies.

It's essential when you leave the hospital to not put too much pressure on
yourself immediately. The first few months after hospitalization are the
most likely for a relapse to occur. If you have a family, you may find your
return home quite chaotic at first compared to the hospital's quiet setting.
A return home also means a return to regular responsibilities, which may
seem daunting at first. Your return home should be discussed with
hospital staff before leaving. Where possible, community resources
should be taken advantage of to assist with your return to day-to-day
activities.

Once home, it would be best if you put your needs as a priority. Good
self-care can go along way to preventing a relapse of symptoms. Discuss
with your doctor or social worker good self-care habits, potential triggers,
stress reduction techniques, and a plan of action in the event of a relapse.
It's also essential to work on your support system of family, friends, and
community resources. These are the people who can help you prevent
relapse and additional hospitalizations.
Chapter Nine: The Importance of Self
Care

Self-care is how you look after yourself regularly. It involves

everything from your routine to exercise, eating, sleep patterns,
relationships, and diet. It encompasses every activity that contributes to
how you feel both physically and mentally. Each individual's self-care
routine is different and can be very personalized. Small changes in different
areas can contribute to greater self-awareness. This can help recognize
certain traits, emotions, and behaviors that can identify early warning signs
and relapse triggers. By working on an effective self-care plan, the risk of
hospitalization can be significantly reduced.

Self-care can be tricky, and when an individual is sick or experiencing

episodes, self-care is even more challenging. Individuals can go days or
even weeks without showering, forget to eat, neglect responsibilities like
paying bills and cleaning. They may not take their medication or attend
medical or therapy appointments. Many of these tasks can seem
overwhelming and difficult, creating unwanted challenges.

Sounds, movement, smell, etc., can be an aggravating factor in

hygiene routines. The simple use of toothpaste or a hairbrush touch can be
very overstimulating during an active episode.
 Starting small helps to improve self-care and reduce the challenges of
daily life. Beginning with one small task and not focusing on the more
significant challenges, individuals can establish a sense of accomplishment.
Attempting another task the next day can improve self-confidence and
awareness. As time progresses, additional activities and self-care methods
can be added.

When establishing a self-care routine, several essential components

should be included—these range from personal hygiene, mental health
issues to general health.

Self Care Components

Sleep: Adequate sleep cannot be stressed enough as lack of sleep or

diminished sleep is a leading trigger factor for many individuals. Sleep
quality is also just as important as sleep quantity. Individuals who are
suffering from poor sleep patterns should discuss this with their doctor.
Various medications can help to improve sleep. Also, some antipsychotic
drugs can cause sleep issues, and a change in medication may be necessary.
An increase in physical exercises such as a daily walk and good nutrition
will also improve sleep quality.

Taking medications: Taking prescribed medications regularly is the

first line of defense against relapse and hospitalization. Setting medication
alarms or having medication pre-sorted in pharmacy packets or pillboxes
will serve as a reminder to take and keep medication regimes on track.

Exercise: individuals with schizoaffective disorder are at a higher risk

for several health complications such as obesity, cardiovascular issues, and
diabetes. Regular participation in physical activity can reduce risk, help
maintain weight and improve overall mental health and sleep quality.

Nutrition: the saying you are what you eat is an appropriate one. By
improving nutrition, individuals can lessen weight gain and improve overall
health. Proper nutrition also helps to stabilize blood sugar levels which
helps to regulate mood and energy levels.
Reduce stress: stress is a significant trigger for individuals with
schizoaffective disorder. Recognizing situations that increase stress levels
can help reduce the risk. Participating in stress-relieving activities such as
regular exercise, yoga, meditation, mindfulness, massage, and reflexology
can help. Fidget toys and worry stones can also help to release pent-up
frustrations and to diminish anxiety.

Attend regular medical appointments: Your medical team provides

an extra safety net for preventing relapse. By maintaining a good
relationship with your caregivers and attending regular meetings, your
medical team will be able to intervene when necessary when warning signs
appear. They will also better treat side effects and monitor the effectiveness
of your medication and treatment plans.

Maintain your support system: reach out and keep in touch with your
support system and caregivers. This allows them to see how your doing,
intervene when necessary, and give you the additional encouragement and
support you need. Doing so also enables you to ask for help when you need
it, whether with organizing financial responsibilities, housework,
schoolwork, or employment.
Take advantage of resources in your area: counseling, group and peer
support, help with social skills, alternative therapies such as art, music,
nature or animal therapy, help with living arrangements, and employment
are some of the community resources that may be available and can help
with self-care and maintenance.

Learn to recognize warning signs: knowing the warning signs and

triggers for possible relapse is vital and should be noted. This information
should also be shared with support networks, medical team members, and
caregivers so that everyone can work together to prevent relapse and
hospitalization.

Plan for a crisis: no one wants to think about a crisis episode, but the
reality of schizoaffective disorder is that it will occur even with the best
possible care and treatment. Recognizing symptoms and triggers is the first
step in potentially avoiding them. Having a crisis plan is the first step in
dealing with them. A crisis plan should be discussed with medical team
members, support members, and caregivers so that individual needs and
wants are known if you cannot communicate them yourself. This also
allows for treatment plans, a chosen treatment center, who will be
contacted, religious views, etc. Having a plan in place also makes child and
pet care requirements easier for caregivers. By having all this in writing
before a crisis, an episode can be handled much more professionally and
respectfully, improving the crisis's outcome.

Keep in touch with friends and maintain relationships. While the

people in an individual's friend circle may not be a direct part of their
support system or crisis plan, they play a vital role in encouraging self-care
and improving self-esteem. Wherever possible, these relationships should
be maintained and nourished as much as possible.

Have a mini-crisis plan: a mini-crisis plan is an intervention plan that

helps to prevent a more significant crisis or episode. A mini-crisis plan
should include a list of help centers, friends, or family to help intervene and
numbers for therapists and medical support staff that oversee an individual's
care. This allows for early intervention when warning signs are detected.

Return to or take up new hobbies: music, art writing, nature walks,

bird watching, painting, and even a structured daily routine that involves
various activities can help provide an outlet for emotions, reduce stress, and
improve quality of health.

How Caregivers can support self-care

- Be encouraging, supportive, and encourage a healthy lifestyle

- Adjust expectations. Small steps are significant accomplishments.
Do not expect individuals to return to their previous level of
functioning but encourage a return to activities that can improve
independence and overall health and well-being.
- Watch for relapses. Know the signs.
- Be an active part of crisis planning and medical care
- Stay connected and reach out
 Chapter Ten: Relapse Prevention

Medication is the number one defense against relapse. For medication

regimes to be followed faithfully, the individual must understand the
medication's benefits in reducing symptoms and stress. A good medication
regimen in conjunction with appropriate therapies can help with long-term
goal planning, return to previous activities, and increased independence. A
regular medication regimen can also help stabilize emotions and improve
work, school, and personal relationships.

The best way to maintain a medication regimen is to know your

medications and the benefits they provide. A good understanding of their
side effects is also necessary. Educating yourself on these can quickly tell
when a medication is no longer effective or if a side effect is becoming
particularly troublesome. In both instances, the quicker the medications are
adjusted, the less likely a relapse will occur.

Build your medication doses into a regular daily routine. This can be made
easier by using pillboxes or pharmacy dispersal systems, so your
medication is already pre-sorted. This can result in fewer missed doses.

Some medications like antipsychotics can be administered bi-weekly or

monthly by injection, making it much easier to maintain a regular dosage
schedule. Injectable doses have similar or, in some cases, fewer side effects
depending on the individual and the dosage. This helps if there is an issue
with medication adherence.

Beware of overmedication
Regular maintenance doses of medication do not need to be as high as once
was thought, and hospital stabilizing medications are always given at a
much higher level. Your daily maintenance amounts should always be lower
than those during an acute episode. If you are still on the hospital dosage
after discharge, speak to your doctor about possibly reducing your dose to
alleviate side effects which are common at high doses. Maintain good
communication with your care providers so that medication can be
monitored and adjusted as needed. Waiting too long to correct a problem or
stopping the medication because of unwanted side effects without a doctor's
supervision can trigger a relapse.

Learn to avoid and manage stress

Stress and schizoaffective disorder are not friends, and stress more
than anything else can trigger unwanted symptoms and lead to relapse.
Whenever a stressful event is coming up or cannot be avoided, seek support
from family and friends to mitigate the stress load. Speak to your doctor
about anxiety levels and sleeping patterns during this time.

Significant sources of stress can include:

- New relationships
- Breakups
- Marriage and divorce
- Children
- Death of family member or close friend
 - Job loss
- Moving
- Illness
- Hospitalization
- Exams
- Legal issues
- Accidents
Stress can be managed in several ways, not just by medication and
therapy. Other alternative methods for relieving stress include

- Avoiding modifying or otherwise adjusting exposure to stressful

events
- Adjusting expectations toward the event. For example, grieving for
the death of an individual and the loss of a close relationship is
normal and healthy.
- Maintaining regular activities, stick to routines and activities such as
sports, therapy, and art as much as possible
- Try relaxation techniques such as yoga, meditation, walks
- Reach out to a friend, family member, or therapist talking helps
- Seek help in the divine. If you have a set religious viewpoint or
relief, seek solace and peace in sacred texts or prayer
- Turn to the arts, music, drawing, painting, knitting, writing, etc., can
all help relieve tension
- Take part in a hobby or game you find pleasurable
- Call in your support network and ask for their help or for them to
join you in any of these activities, so you are not alone.
-
Know the signs of a relapse
 Knowing the early warning signs of a relapse can help individuals and
their loved ones to act quickly and possibly avoid a crisis event or
hospitalization. The following symptoms should be monitored and watched
closely when necessary crisis intervention should take place to prevent an
acute episode.

Relapse Early Warning Signs

- Disruptive thoughts
- Feelings of being overwhelmed
- Extreme excessive boredom
- Trouble sleeping/ staying asleep
- Physical problems
- Tense/nervous/agitated
- Angry easily irritated
- Feelings of worthlessness
- Memory or cognitive issues
- Loss or a sudden increase in appetite
- Hallucinations
- Delusions
- Mood shifts (hypomania, mania, or depression)
- Change in energy levels
- Loss of interest in regular activities
- Discouraged about future or no future goals
- Issues with concentration, problem-solving
- Racing thoughts/ speech
- Paranoias
- Disassociated
- Self-isolating/ social withdrawal
- Delusional religious beliefs
- Lonely and sadness
- Difficulty expressing or articulating self.
- Unique individual trigger behavior
Chapter Eleven: Crisis Planning

A significant part of any relapse prevention plan is a Crisis plan.

Essentially ensuring that medical team members, trusted family and
friends, and other members of an individual's support team are aware
of an individual's choices, plans, and advance statements before a
relapse or acute episode.

Having a crisis plan in place means that support members can be on

the lookout for early warning signs and are ready to intervene and
assist. Should an acute episode flare up with little to no warning,
support team members are prepared to act and put an individual's
needs. Requests in play should that individual be unable to
communicate them adequately.

A crisis plan should lay out how to support individuals when early
warning signs creep up. This can include specific things an individual
needs or wants to avoid. This would also include who is to be
contacted, treatment options that are acceptable and those that an
individual wants to avoid, who will act as a patient advocate. This is
where an advance statement, advance directive, or medical power of
attorney may come into play depending on the region's legal
requirements.
 Having an advance statement, directive, or power of attorney in place
allows an individual to layout their needs, requests, contacts, religious
beliefs, and specific treatments. At the same time, they can prevent
problems when and if they become incapacitated in an acute episode.
Assigning a directive or power of attorney to a trusted friend can
relieve added stress over hospitalization and treatment. These types of
directives should include but are not limited to:

- Possible early warning signs and coping skills, intervention

techniques, and procedures
- Supports and resources to have in place to help prevent
hospitalization
- Facility or hospital of choice for treatment
- Personal needs such as childcare, pet care, finances while in
treatment
- Treatment options and interventions such as medication, seclusion,
restraints, ECT, etc.
- A clear concessive as to the involvement of specific caregivers in
individual's care
- Emergency numbers and contact information for family, religious
leaders, medical support team
- 24-hour access to helplines, hospital, and crisis center numbers

Crisis planning should also identify the individual, such as a medic alert
bracelet or medical card in the wallet. This will allow emergency personal
to quickly identify the crisis and contact emergency family contacts,
medical team members, and other listed emergency contacts. This can also
provide a detailed list of medications used to avoid any adverse
complications from mixing medications.

If a crisis does occur, support members should be prepared to react

accordingly.

- Remain Calm
- Evaluate the urgency of the episode.
- Assess how much time is needed to respond appropriately.
- Use available crisis sources.
- Get help.
- Always keep individual and self safe.
- Refer to crisis plan once the individual is safe.
Chapter Twelve: Family Support

A sound family support system is one of the most important things an

individual with schizoaffective disorder can have. These individuals
help during crises and encourage and uplift individuals between
episodes giving them hope and support. These individuals help find
adequate medical care, resources, recognize warning signs, help
prevent acute episodes, monitor and encourage the use of medications,
attend medical appointments, and promote independence wherever
possible.
Providing support for someone with schizoaffective disorder is not
always easy. Still, it can be made easier by taking several steps to help
not only your friend or family member with the illness but also
yourself.

Some important tips for caregivers and family and friend supporters:

- Learn as much as you can about the disorder and encourage your
family member to do the same. The more you know about the illness,
its characteristics, and its treatment, the better decisions that can be
made for treatment and care and support encouragement and
understanding.
- Learn to recognize warning signs of relapse. Often friends and
family are the first to notice a downward decline in personal hygiene
 mood and other symptoms indicating that a relapse is imminent.
- Have a plan for handling relapses, not only for individual care but
also for a supportive approach. Arguing, criticizing, ridiculing, or
alarming behavior can make symptoms worse and stress your family
member escalating the situation to a crisis.
- Have a positive attitude and accept small accomplishments. It is
unlikely that your family member will return 100% to their pre-
illness state, which is okay. Small achievements can eventually lead
to more independence and the ability for self-care. Allow your loved
one to feel okay with the accomplishments they can make.
- Keep a sense of humor.
- Accept help for yourself and your loved one. You do not have to do
it alone. Seek out local resources, support, and peer groups, respite
care, etc.
- Take care of yourself. Self-care for individuals with SZD is essential,
but so is self-care for their supporters and caregivers. You cannot
help anyone if you do not take care of yourself. Schizoaffective
disorder can be frustrating, tiring, and emotionally challenging for
caregivers as well as patients.
- Engage in physical activities, healthy recreational activities, games,
and hobbies to provide stress relief.
- Stay healthy and optimistic
- Do not lose touch with your friends and family as well as your
support system.
- Have realistic expectations. Individuals will not always be happy,
coherent, and or accept your help or acknowledge your feelings as
they are often caught up in their own. This is not a personal attack or
plot against you. It is the illness speaking.
 - Emotions are allowed
- Provide patience, acceptance, and support
- Relapses are not an if. Even on a well regimented treatment plan,
when breakthrough symptoms can occur, be prepared and accept
them.
- Not everyone recovers, and while some may recover a certain level
of functioning and independence, expectations of previous levels of
functioning are unrealistic.
- Accept the illness and the person, do not compare to others' recovery.

Remember dealing with a family member with schizoaffective

disorder can cause various emotions such as loss, grief, shock, sadness,
anxiety, and fear. This is not uncommon and is perfectly normal reaction
to a chronic mental illness.
These reactions are widespread with schizoaffective disorder as it is
challenging to deal with, has no cure.

.
Caregivers for individuals with schizoaffective disorder need to be
dedicated patient individuals who are willing to understand the condition
and its treatments to provide support and encouragement in areas such as
self care, medication adherence, and treatment management. Caregivers
will have to be familiar with and on the lookout for early signs of
relapse, triggers, and respond to crisis and acute episodes when
necessary. Being a caregiver for an individual with schizoaffective
disorder can, depending on the individual's condition, be a full-time
commitment, yet caregivers can be the first line of support,
encouragement, and empowerment for their family member. Caregivers
should always focus on the individual and not the mental illness. By
doing so, they will establish a higher level of trust with the individual
and a greater likelihood of successful treatment.

Providing a Supportive Environment

- Remember to communicate, especially between episodes, so needs

and wants are known and respected.
- Individuals with SZD can suffer from cognitive issues, trouble
concentration, deductive reasoning, and memory problems, leading
to a need for increased time to process and answer questions and
concerns. Patience, understanding, and monitoring are needed when
these symptoms are present.
- Stress on the caregiver can cause further tension and frustration for
the individual, so taking time for individual self-care is vital for both
individuals.
- Conflict is a significant issue with caregivers and individuals with
SZD. Despite the frustration, caregivers must refrain from blaming,
criticizing, ridiculing, or causing alarm. Communication in these
instances is vital, and caregivers should remain calm but speak
directly to the point. Remember to ask the individual what they
think, need, or want while keeping the individual focused on the
current situation and goal at hand. Caregivers should be open to
compromise if it does not cause further problems or endanger the
individual they are caring for.
Things to remember:
- All individuals with schizoaffective disorder will experience acute
psychotic episodes at various times during their illness.
- Many experience mild symptoms outside of acute episodes and
roughly ½ have persistent symptoms all the time.
- Do not feed hallucinations or delusions but rather discuss the
feelings caused by these events, listen, show concern and support but
do not show anger, frustration, or alarm.
- Manage difficult situations calmly and by evaluating the individual's
needs. Use stress-reduction techniques, redirection to talk, and
structured schedules and routines to help alleviate potential conflict.
Set realistic expectations and use communications skills.
- Seek out outside resources where available to assist with care.
 Chapter Thirteen: Suicide
Prevention

Individuals with schizoaffective disorder are more likely to commit or

attempt suicide than those who do not have the condition. Their
susceptibility is 10% of individuals within the first ten years of onset. Their
high impulsivity level makes the risk even higher when depression, drops in
mood, or an increase in symptoms are present. This impulsivity increases
the risk of acting on suicidal thoughts and ideations.
The highest risk is for schizoaffective patients who are young, white,
single males, individuals of higher intelligence, and those who were higher
functioning before the onset of the disorder. Individuals who have substance
abuse problems or who are highly
aware of the impact of their illness are also at an increased risk.

Further risk factors include those who cannot work and depend on
others, individuals without an adequate support system, individuals just
leaving hospital, individuals with a long-term illness or chronic pain. Risk
factors are higher for those with a family history of suicide. High levels of
impulsivity, those who have regular thoughts of suicide, have lost hope in
their treatment plan and exhibit feelings of hopelessness, a negative outlook
on life, and a sense of worthlessness.
 Caregivers should be keenly aware that individuals with
schizoaffective disorder can commit suicide without warning; however,
everyone else needs to talk and discuss feelings and thoughts that trouble
them. This can be the first line of defense in protecting individuals from
harming themselves.

Talking to individuals about their thoughts and feelings, even suicidal

ideation, can help relieve stress and frustration on the individual's part.
Discussing the subject will not cause an individual to get the idea to commit
suicide. It is essential when asking them how they feel that caregivers show
interest but not alarm.
Caregivers, friends, and family should never ignore talk of suicide,
even if mentioned in jest. Most individuals who commit suicide talk about it
at some point prior to attempting. By asking questions and showing
concern, caregivers and supporters can determine how serious the
individual is. Most individuals who are willing to discuss their suicidal
thoughts and ideations have mixed feelings about them. They often have a
plan but are hesitant to act as they want to continue living but find doing so
exceedingly complex, painful, and depressing. Sometimes the urge is only
temporary, and something as simple as an adjustment of medications can
help relieve or even resolve the issue entirely. Intervention is key.
Referencing other individuals who have been successful in their
suicide attempts, such as stars like Robin Williams, can be a sign of intent.
Commanding hallucinations can also put an individual in a position to
consider suicide.
In these instances, caregivers should assess the situation carefully
while being supportive and expressing concern for the individual.
Caregivers should evaluate the risk for self-harm and consider all talk of
suicide as a risk. Whenever possible, the individual should be assessed by a
professional as quickly as possible.

If the individual has already or is attempting to harm themselves,

emergency services should be called immediately. In self-harming behavior,
the individual should be monitored and distracted until emergency services
can arrive. Asking the individual how they feel if they have any plans to
harm themselves if there is anything that might change their minds, such as
family members, a special pet, etc. This not only will distract the individual
from further harm but hopefully provide some insight into their state of
mind.
Protect the individual, do not allow them out of your sight. Remove all
potentially lethal items from their proximity or prevent them from leaving
the area not to gain access to these items.

Once the individual has been safely seen by a professional or

transferred to the hospital, continue to lend support and encouragement.
Keep notes of information, behavior, and specific warning signs included in
the individual's crisis plan.
 Chapter Fourteen: Patients Speak

Many individuals diagnosed with Schizoaffective Disorder find themselves

in a similar situation of lack of information and misinformation from the
start of the illness. Over the years of treatment and therapy, many things
have come to light both from a medical perspective and from a personal
perspective. The following list is from actual patients who answered the
question. What do you wish you had known. I hope that almost if not all,
these questions have been answered as best as possible in this guide, and
those that have not can be addressed with your health care provider.

What I wish I had known early on

- Acceptance. I cannot return to the previous version of functioning at

school and work that I once had.
- Misdiagnosis is common, and it is a hard disorder to diagnosis
- So many stereotypes that need to be broken
- No natural remedy will cure it completely
- How to better read and react to symptoms to better manage the
disorder
- Side effects and damage from medication
- That family understood I am not dangerous to be around
- Sleep is super important to maintain
- Recognizing and accepting symptoms as part of life character makes
 life and management easier
- The voices are not real
- Finding the right environment and people will make things better,
accepting that you are enough and valuable despite your illness
- How to support family members with the disorder (parent)
- That it's not my fault
- How to accept the change in this person (family member)
- Vulnerable hidden medical condition
- There is hope.
 Chapter Fifteen Stigmas &
Stereotypes

Stigmas and stereotypes surrounding mental illness are rampant thought-out

society, even in our modern age. Schizophrenia and Schizophrenic spectrum
disorder are perhaps the least understood and most stereotyped of all mental
health disorders. Stereotypes range from violence, multiple personalities,
low intelligence, laziness, etc. The perpetuation of these stereotypes by
friends and family members can be a significant issue for individuals
suffering from schizoaffective disorder adding unnecessary stress and
conflict. By understanding the disorder and the myths surrounding it,
friends and family can better support an individual's recovery and daily
maintenance of schizoaffective disorder.

True or False

Schizophrenic spectrum disorders mean an individual has multiple

personalities.

False. The term schizophrenia means "a break from one's mind," meaning a
break from reality which describes the symptoms of psychosis, either
delusions or hallucinations. Individuals who have Schizophrenia or
schizoaffective disorder diagnosis do not have multiple personalities.
Personality Dissociative Disorder (multiple personality disorder) is a
complete and separate diagnosis and is exceptionally rare.

Individuals with Schizophrenia or schizoaffective Disorder are not

intelligent.

False. Because schizophrenia and Schizoaffective disorder can cause,

cognitive impairment individuals may need more time to process
information and respond to questions. That does not mean they're less
intelligent than the average person. Cognitive impairment affects the
processing of information, memory, and organizational skills. With proper
treatment, these symptoms can be controlled or, in some cases, alleviate all
together.

Individuals with Schizophrenia or schizoaffective Disorder are overweight

because they are lazy.

False. Obesity is a significant issue for many individuals with mental health
problems due to both symptoms and medication. Many illnesses such as
schizoaffective disorder and major depressive Disorder (to name two) have
negative symptoms such as lack of motivation, depression, loss of ability to
plan, loss of pleasure in daily activities, diminished capacity to begin, and
sustained activities. These are often mistaken for laziness, but the reality is
the disorders make it impossible to overcome the symptoms without help.
Medications also add to the effect as some medicines can cause brain fog,
drowsiness, and confusion. Most antipsychotics also alter metabolism rates
and are known for eight gain as a side effect. Some medications such as
Seroquel are notorious for high levels of weight gain, while others such as
Latuda and Abilify are weight neutral or considered to have a lesser impact
on weight gain.

Individuals with Schizophrenia and Schizoaffective Disorder are violent.

False. Individuals with Schizophrenia or Schizoaffective Disorder are no

more or less violent than the average public. While in psychosis, some
individuals may experience higher aggression or agitation levels, the risk to
other individuals is minimal in all but a few rare circumstances. Individuals
abusing drugs or alcohol may be more inclined to more violent episodes
and non-medicated episodes. Individuals with Schizophrenia or
schizoaffective disorder are more likely to be victims of violence and abuse
than to perpetrate it. Due to cognitive dysfunction, psychosis, and ongoing
symptoms, these individuals can be taken advantage of in several ways.
Individuals are more likely to be victims of financial crimes, sexual,
emotional, physical abuse, discrimination, and poverty.

Individuals with Schizophrenia or schizoaffective Disorder are crazy all

the time.

False. Individuals with these disorders suffer from symptoms and episodes
like patients of other illnesses such as asthma or diabetes. Symptoms can be
controlled and managed with therapy, medication, and, if necessary,
hospitalization like any other illness.
While there can and will be breakthrough symptoms from time-to-time
individuals will not suffer from severe episodic symptoms all the time. It is
not unusual for some individuals to have continual hallucinations or long-
term delusions; however, the severity of these symptoms can be managed
and controlled. Some individuals report continual symptoms but at a level
that they can continue to work and function daily.

If a person with Schizophrenia or schizoaffective Disorder is acting up or

is agitated, depressed, or upset, they are off their medication.

False. Perhaps the biggest stereotype of all of this illness is the belief that
individuals cannot have a bad day without being off their medication.
Almost all patients report that at one point or another, a change in attitude
or temperament resulted in queries from friends, family, and coworkers as
to whether or not they had taken their medication that day.

Individuals with Schizophrenia and schizoaffective Disorder, like anyone

else, have regular emotions and can and react to events around them. Being
angered, upset, saddened, or agitated by an event at school or work, a
change in relationship, or how they were treated is a normal healthy
reaction to daily events. The extreme overreaction or lack of reaction to an
event should warrant a closer look at an individual's symptoms. The best
response to anyone having a bad day is, "Do you need to talk?".

All schizophrenics and individuals with schizoaffective disorder commit

suicide sooner or later. It's just a matter of time.
False. While individuals with these disorders are at a higher risk of suicide,
being diagnosed is not a guarantee of suicidal ideation or intention.
Statistically, individuals with schizophrenic spectrum disorders kill
themselves at a rate of 5 times higher than the public (or 5%). Over ten
years (from diagnosis), 10% commit suicide, and over 30 years, that
number is 15%. Most of these individuals are not on medication. It is
important to note that at both the ten-year and 30-year mark, 25% of
individuals have recovered entirely while others have improved to a level of
complete or support-aided independence.

Schizophrenics and individuals with schizoaffective disorder cannot be

good parents.

False. Depending on the severity of the symptoms and treatment an

individual is getting, many patients can marry and raise families without
issue. Some may require extra support and therapy, but it is by no means a
reason to believe that these individuals are not good parents.

If your family member has a schizophrenic spectrum disorder, you will

inherit it too (or your children will get it if you have it).

False. There is no specific known cause of schizophrenia or schizoaffective

disorder. It is believed to be caused by a combination of factors. The risk of
inheritance is only 10% if a parent has the condition.

You cannot work with Schizophrenia or schizoaffective disorder.

False. While it may be impossible for some individuals to work with the
disorder, it is impossible for all individuals. Some patients can work full
time at jobs that have little to no stress. Others only managed part-time
positions while others still can only manage volunteer hours. Some patients
may not be able to work due to the level of stress or organizational skills
needed and the severity of the symptoms. Having Schizophrenia or
schizoaffective Disorder does not immediately preclude an individual from
working, but rather it is based on each individual's severity of symptoms
and abilities.
 Epilogue

While this guide does not cover everything, there is to know about
schizoaffective disorder. I hope that there is enough information here for
individuals to use as a starting point in seeking and maintaining treatment
that can help manage symptoms.
The information here is a collaboration of endless hours researching
symptoms, medication treatment, and individual experiences.

It is important to note that no two individuals will experience this

disorder in the same manner, and medication and treatment options affect
every patient differently.

Not every patient will have a complete recovery. Daily management is

possible with good treatment. Continuous treatment and good self-care are
the best options for a successful outcome. This guide was made to help
individuals use this information to participate in their care and recovery.
With good care, there is hope.

If you enjoyed this guide, please return to Amazon to give it a review.

Please keep your eyes out for my Schizoaffective Disorder Self-Care Guide,
covering Self-Care and Self-Care methods more in-depth. It's a great
addition to this guide for both patients, their families, and their caregivers.
My Schizoaffective Disorder: Self Care Guide will be releasing in Spring of
2021.

Excerpt
365 Ways To Be Happy & Improve
Your Mental Health From meditation
and yoga to hosting a murder. Self-
care has never been more relaxing
and fun. Help relieve anxiety and
stress from the everyday go go go.
Laugh out loud, sing in the shower,
dance like no one is watching, and
get your Madonna on. 365 sure-fire
ways to improve your mood and your
mental health.
Preface
There was a time when Mental
Health was not considered part of the
overall health of an individual. Times
have changed, and we now know that
mental health affects us emotionally
and physically. We also know that
mental health issues are more
prevalent in society than was once
thought.
Mental Health and Mental Illness are
far too stigmatized and should be
discussed regularly. We should pay as
much attention to each other's state of
mind and emotional well-being as we
do our physical well-being. This
book was written to help encourage
positive thinking and action in our
day-to-day lives. If you or someone
you know struggles with mental
health issues, please seek professional
treatment and or therapy.

One Exercise. Exercise has so many benefits for the body that they
are all hard to name. But when it comes to your mental and physical well-
being, exercise should always be on the daily priority list. Exercise
increases blood flow throughout the body, which includes the brain. A
healthy brain is much more able to process events and emotions
appropriately.
 A good round of exercise also reduces stress and anxiety. It’s hard to stay
mad or anxious after a good run. You are more likely to have a clearer mind
and subsequently clearer thoughts that help when dealing with stressful
events and anxiety. A clear mind can help reason and calm. Exercise will
also improve your overall physical health and allow you to have a better
sleep at night, improving your overall mental health.
Starting an exercise regime doesn’t have to be stressful. It can be as
simple as just adding a walk to your day. Something as small as walking to
the next bus stop instead of the one in front of your house, walking to work
instead of driving, or taking the stairs instead of the elevator. Ideally, you
should pause throughout the day and do a bit of physical exercise. If you
can strive to throw in a good stretch or even some yoga moves every hour
to improve your overall health and work performance! You will feel better.

Two Yoga A lot like meditation, yoga is one of those great types of
exercise described as “self-soothing” and is set to help with stress, anxiety,
and depression by lessening how much these events affect your body. Yoga
can help decrease your resting heart rate and your blood pressure and
lighten your breathing rate. This is how it allows you to deal with stress.
Yoga requires little space and little to no equipment, so it can
ideally be done just about anywhere, including small spaces like an office
cubicle. Have a job where you are teaching or working with others. Ask
them to join in. Pause throughout the day and throw in some yoga for good
health and a good mood.

Three Meditation. Many people have a misconception of what

meditation is. Some believe that you have to focus all inward and tune out
everything but your breathing. That would be the cause if you were using
breathing as the thing you are focusing on. Not a bad idea but you can focus
on anything from a sound to a thought, your breath, an object, or even a pet.
You can focus on your computer screen while meditating, and no one will
know.
Meditation like Exercise and Yoga is used to relieve stress and
anxiety and clear the mind by channeling one’s attention on one “item,”
slowing the breathing process and finding a calm place. By putting all your
focus on one thing, you can achieve this by tuning out the surrounding
distractions causing stress or disorganized thinking. Meditation also has the
added benefit of improving cognitive functioning to think more precisely
and better handle stress and emotions.
Take a few minutes each day, find a spot anywhere at all, even at
your desk, and focus on an object or a thought—just breath and focus.

Four Nutrition. This one should be a no-brainer. Good nutrition is

essential for a healthy body, but did you know it can seriously affect your
mind. Processed foods, refined grains, and sugars make us sluggish and
raise and lower our blood sugar at alarming rates. A good diet including
high protein, vitamins, and minerals like vitamin D, B complex, folate, zinc,
and iron are essential to good brain health. Throw in some omega-three
fatty acids, and your brain will feel an almost immediate boost.
The western diet is primarily processed foods, fast food restaurants, soft
drinks, and sugar. It leaves extraordinarily little space for fresh vegetables,
fruits, and healthy grains and proteins. By changing your diet, you not only
help your physical health, but you will feel happier, less sluggish, have
more energy and sleep better too. Pack up a lunch for work, take the stairs,
and smile!

Five Relaxation. Relaxing should be something we all do every day,

at least once a day, and not just when we come home from work. Resting is
essential to reduce stress anxiety and relieving depression. Good regular
relaxation techniques can also help to alleviate chronic pain and reduce the
risk of heart disease. Take time in your day for a good walk, a good book, a
bit of meditation, or even a nap if it helps you to relax a bit more.

Six Reduce Stress .Oh, stress stress stress, just the mention of the
word causes stress. In a perfect world, it would not exist. But sadly, we need
stress as much as we need relaxation. If we never had stress, we would be
unable to react in an emergency due to a lack of stress response. Of course,
that does not mean that it is good to be overloaded with stress.
It should always be a priority to avoid high levels of stress at all costs. Of
course, there are times when some stress is necessary, but other times it can
be avoided. Try to limit your stress level by avoiding things that trigger a
high-stress response. This includes toxic people, high-demand events, and
long travel times (airports imparticular, try the train next time). Avoid
procrastinating projects to help reduce last-minute stress and give yourself
more time to prepare and execute. Whenever possible, prepare meals,
agendas, and plans well in advance to make things as smooth as possible.

Seven Reduce Anxiety Stress and anxiety seem to make great

bedfellows. One follows the other and vice versa. Stress causes anxiety, and
anxiety causes more stress. Reduce one, and you will have an easier time
with the other and possibly will be able to remove both from your daily life.
Exercise like walking and meditation are great ways to reduce anxiety.
Other methods are regular routines, breathing exercises, yoga, and
relaxation periods. When all else fails, sometimes medication can help an
already established anxiety reduction routine.

Eight Increase Rewards Certain activities have a way of

affecting the brain's development of dopamine. Dopamine is a chemical in
the brain that produces a reward sensation. By increasing dopamine levels,
you can improve your mood.
Activities that increase dopamine levels include exercise, sex,
challenging activities like puzzles and games: music, and dance.
Nine Hot Bath vs. Shower Sometimes a shower can be
overstimulating and nowhere near pleasant. Baths are proven to be more
relaxing than showers and better for mental and emotional health.
Pouring yourself a warm relaxing bath can also help induce sleep and
therefore reduce anxiety and stress. So take some time to have a nice long
hot bath regularly.

Ten Pamper Yourself There is nothing selfish about a bit of self-

pampering. It's necessary to replenish your energy levels and help with
relaxation.
Spend some time with a good meal, a hot bath, a home spa day, reading a
good book, taking a nap, getting a new hair cut, or just sitting enjoying the
silence, whatever you chose to do to treat yourself.

365 Ways to Be Happy & Improve Your Mental Health releases on

Amazon April 2021.