existing system. because of dsm-5's continuing problematic categorical foundation, schizoaffective disorder's conceptual and diagnostic validity remains doubtful. after enough research is completed and data exists, future diagnostic advances will need to either eliminate and replace, or soften and bridge, the hard categorical separation of mood disorders from schizophrenia; most likely using a spectrum or dimensional approach to diagnosis. more parsimonious definitions than the current one were considered by carpenter and the dsm-5 workgroup: one option for the dsm-5 would have been to remove the schizoaffective disorder category and to add affective symptoms as a dimension to schizophrenia and schizophreniform disorder or to define a single category for the co-occurrence of psychosis and mood symptoms. this option was extensively debated but ultimately deemed to be premature in the absence of sufficient clinical and theoretical validating data justifying such a … reconceptualization. additionally, there appeared to be no practical way to introduce affect dimensions covering the entire course of illness, that would capture the current concept of periods of psychosis related and unrelated to mood episodes. o valid biomarkers or laboratory measures have emerged to distinguish between affective psychosis and schizophrenia. to the contrary, the idea of a dichotomy between these types of conditions has proven naïve. he admixture of "schizophrenic" and affective symptoms is a feature of many, or even most, cases with severe mental illness. most presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response in psychosis. ltimately a more ... dimensional approach will be required. the field of psychiatry has begun to question its assumptions and analyze its data in order to merge closer with evidence-based medicine. the removal of the "episode diagnosis", and the addition of two episodes of psychosis, as qualifications for the dsm-5 schizoaffective diagnosis, may improve the diagnosis' consistency over dsm-iv for research purposes, where diagnostic criteria are by necessity followed exactingly. but the new definition remains long, unwieldy, and perhaps still not very useful for community clinicians—with two psychoses, one for two weeks minimum and without mood disorder (but the person can be mildly or moderately depressed) and the other with significant mood disorder and psychosis lasting for most of the time, and with lasting mood symptoms for most of the residual portion of the illness. community clinicians used the previous definition "for about a third of cases with non-affective psychotic disorders." non-affective psychotic disorders are, by definition, not schizoaffective disorder. for clinicians to make such sizeable errors of misdiagnosis may imply systemic problems with the schizoaffective disorder diagnosis itself. already, at least one expert believes the new schizoaffective definition has not gone far enough to solve the previous definition's problems. from a scientific standpoint, modern clinical psychiatry is still a very young, underdeveloped medical specialty because its target organ, the human brain, is not yet well understood. the human brain's neural circuits, for example, are just beginning to be mapped by modern neuroscience in the human connectome project and clarity. clinical psychiatry, furthermore, has begun to understand and acknowledge its current limitations—but further steps by the field are required to significantly reduce misdiagnosis and patient harm; this is crucial both for responsible patient care and to retain public trust. looking forward, a paradigm shift is needed in psychiatric research to address unanswered questions about schizoaffective disorder. the dimensional research domain criteria project currently being developed by the u.s. national institutes of mental health, may be the specific problem solving framework psychiatry needs to develop a more scientifically mature understanding of schizoaffective disorder as well as all other mental disorders. treatment the primary treatment of schizoaffective disorder is medication, with improved outcomes using combined long-term psychological and social supports. hospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it) involuntarily. long-term hospitalization is uncommon since deinstitutionalization started in the 1950s, although it still occurs. community support services including drop-in centers, visits by members of a community mental health team, supported employment and support groups are common. evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizoaffective disorder. because of the heterogeneous symptomology associated with schizoaffective disorder, it is common for patients to be misdiagnosed. many people are either diagnosed with depression, schizophrenia, or bipolar disorder instead of schizoaffective disorder. because of the broad range of symptoms of schizoaffective disorder, patients are often misdiagnosed in a clinical setting. in fact, almost 39% of people are misdiagnosed when it comes to psychiatric disorders. while various medications and treatment options exist for those diagnosed with schizoaffective disorder, symptoms may continue to impact a person for their entire lifespan.schizoaffective disorder can affect a person's ability to experience a fulfilling social life and they may also exhibit difficulty forming bonds or relationships with others. schizoaffective disorder is more likely to occur in women and symptoms begin manifesting at a young age. therapy psychosocial treatments have been found to improve outcomes related to schizoaffective disorder. supportive psychotherapy and cognitive behavioral therapy are both helpful. intensive case management (icm) has been shown to reduce hospitalizations, improve adherence to treatment, and improve social functioning. with icm, clients are assigned a case manager responsible for coordination of care and assisting clients to access supports to address needs in multiple areas related to well-being, including housing. psychiatric/psychosocial rehabilitation is often a component of schizoaffective disorder treatment. this rehabilitation method focuses on solving community integration problems such as obtaining and keeping housing and increasing involvement in positive social groups. it also focuses on improving and increasing activities of daily living; increasing daily healthy habits and decreasing unhealthy behaviors, thereby significantly improving quality of life. psychiatric rehabilitation may also focus on vocational rehabilitation. evidence suggests that cognition-based approaches may be able to improve work and social functioning. psychiatric rehabilitation consists of eight main areas: psychiatric (symptom reduction and management) health and medical (maintaining consistency of care) housing (safe environments) basic living skills (hygiene, meals , safety, planning and chores) social (relationships, family boundaries, communication and integration of client into the community) education and vocation (coping skills, motivation and suitable goals chosen by client) finance (personal budget) community and legal (resources) medication antipsychotic medication is usually required both for acute treatment and the prevention of relapse. there is no single antipsychotic of choice in treating schizoaffective disorder, but atypical antipsychotics may be considered due to their mood-stabilizing abilities. to date, paliperidone (invega) is the only antipsychotic with fda approval for the treatment of schizoaffective disorder. other antipsychotics may be prescribed to further alleviate psychotic symptoms. though not approved for treatment use by the fda, research suggests that clozapine may also be effective in treating schizoaffective disorder, particularly in those resistant to initial medication. clozapine is an atypical antipsychotic that is recognized as being particularly effective when other antipsychotic agents have failed. when combined with cognitive therapy, clozapine has been found to decrease positive and negative symptoms of psychosis at a higher rate in schizoaffective individuals. clozapine has also been associated with a decreased risk of suicide in patients with schizoaffective disorder and a history of suicidality. despite this, clozapine treatment may be ineffective for some patients, particularly in those that are already drug-resistant. the management of the bipolar type of schizoaffective disorder is similar to the treatment of bipolar disorder, with the goal of preventing mood episodes and cycling. lithium or anticonvulsant mood stabilizers such as valproic acid, carbamazepine, and lamotrigine are prescribed in combination with an antipsychotic. antidepressants have also been used to treat schizoaffective disorder. though they may be useful in treating the depressive subtype of the disorder, research suggests that antidepressants are far less effective in treatment than antipsychotics and mood stabilizers. some research has supported the efficacy of anxiolytics in treating schizoaffective disorder, though general findings on their effectiveness in treating schizoaffective disorder remain inconclusive. due to the severe negative outcomes associated with many anti-anxiety drugs, many researchers have cautioned against their long term use in treatment. electroconvulsive therapy electroconvulsive therapy (ect) may be considered for patients with schizoaffective disorder experiencing severe depression or severe psychotic symptoms that have not responded to treatment with antipsychotics. epidemiology compared to depression, schizophrenia, and bipolar disorder, schizoaffective disorder is less commonly diagnosed. schizoaffective disorder is estimated to occur in 0.3 to 0.8 percent of people at some point in their life. 30% of cases occur between the ages of 25 and 35. it is more common in women than men; however, this is because of the high concentration of women in the depressive subcategory, whereas the bipolar subtype has a roughly even gender distribution. children are less likely to be diagnosed with this disorder, as the onset presents itself in adolescence or young adulthood. history the term schizoaffective psychosis was introduced by the american psychiatrist jacob kasanin in 1933 to describe an episodic psychotic illness with predominant affective symptoms, that was thought at the time to be a good-prognosis schizophrenia. kasanin's concept of the illness was influenced by the psychoanalytic teachings of adolf meyer and kasanin postulated that schizoaffective psychosis was caused by "emotional conflicts" of a "mainly sexual nature" and that psychoanalysis "would help prevent the recurrence of such attacks." he based his description on a case study of nine individuals. karl kahlbaum (1828–1899) other psychiatrists, before and after kasanin, have made scientific observations of schizoaffective disorder based on assumptions of a biological and genetic cause of the illness. in 1863, german psychiatrist karl kahlbaum (1828–1899) described schizoaffective disorders as a separate group in his vesania typica circularis. kahlbaum distinguished between cross-sectional and longitudinal observations. in 1920, psychiatrist emil kraepelin (1856–1926) observed a "great number" of cases that had characteristics of both groups of psychoses that he originally posited were two distinct and separate illnesses, dementia praecox (now called schizophrenia) and manic depressive insanity (now called bipolar disorders and recurrent depression). kraepelin acknowledged that "there are many overlaps in this area," that is, the area between schizophrenia and mood disorders. in 1959, psychiatrist kurt schneider (1887–1967) began to further refine conceptualizations of the different forms that schizoaffective disorders can take since he observed "concurrent and sequential types". (the concurrent type of illness he referred to is a longitudinal course of illness with episodes of mood disorder and psychosis occurring predominantly at the same time ; while his sequential type refers to a longitudinal course predominantly marked by alternating mood and psychotic episodes.) schneider described schizoaffective disorders as "cases in-between" the traditional kraepelinian dichotomy of schizophrenia and mood disorders. the historical clinical observation that schizoaffective disorder is an overlap of schizophrenia and mood disorders is explained by genes for both illnesses being present in individuals with schizoaffective disorder; specifically, recent research shows that schizophrenia and mood disorders share common genes and polygenic variations. emil kraepelin (1856–1926). embracing the kraepelinian dichotomy in dsm-iii in 1980, while a step forward from psychodynamic explanations of the disorder, introduced significant problems in schizoaffective disorder diagnosis, as explained recently by the dsm-5 workgroup. schizoaffective disorder was included as a subtype of schizophrenia in dsm-i and dsm-ii, though research showed a schizophrenic cluster of symptoms in individuals with a family history of mood disorders whose illness course, other symptoms and treatment outcome were otherwise more akin to bipolar disorder than to schizophrenia. dsm-iii placed schizoaffective disorder in "psychotic disorders not otherwise specified" before being formally recognized in dsm-iii-r. dsm-iii-r included its own diagnostic criteria as well as the subtypes, bipolar and depressive. in dsm-iv, published in 1994, schizoaffective disorders belonged to the category "other psychotic disorders" and included almost the same criteria and the same subtypes of illness as dsm-iii-r, with the addition of mixed bipolar symptomatology. dsm-iv and dsm-iv-tr (published in 2000) criteria for schizoaffective disorder were poorly defined and poorly operationalized. these ambiguous and unreliable criteria lasted 19 years and led clinicians to significantly overuse the schizoaffective disorder diagnosis. patients commonly diagnosed with dsm-iv schizoaffective disorder showed a clinical picture at time of diagnosis that appeared different from schizophrenia or psychotic mood disorders using dsm-iv criteria, but who as a group, were longitudinally determined to have outcomes indistinguishable from those with mood disorders with or without psychotic features. a poor prognosis was assumed to apply to these patients by most clinicians, and this poor prognosis was harmful to many patients. the poor prognosis for dsm-iv schizoaffective disorder was not