Some people display features of both schizophrenia and an affective disorder such as bipolar disorder or major depression with psychotic features. In depression, the person may experience hallucinations or delusions about guilt, disease or death and be slowed down in speech, thinking and movement. In bipolar disorder, there are depressive and manic phases of illness. In the manic phase, the content of the hallucinations and delusions is usually grandiose and the person is likely to be very energetic, talkative, sleepless and overassertive. But if the illness also displays, at times, psychotic symptoms with a neutral content — bizarre beliefs, messages or behavior that do not reflect a depressed or elevated mood — then the diagnosis could be schizoaffective disorder.
Mania and depression are usually episodic and can be interspersed with long periods of complete remission of symptoms. If the illness is continuous, with no remission, then the diagnosis may be schizoaffective disorder.
The treatment for schizoaffective disorder, bipolar disorder and major depression with psychosis is very similar. If both manic episodes and depressive episodes are evident, the medications used are likely to include antipsychotic agents and mood stabilizers. If the illness only presents with depressive features and no manic symptoms at any time, then antidepressants are likely to be used.