during the initial 2 months, both depressive  and psychotic symptoms present during the
next 3 months, and psychotic symptoms alone pr esent during the last month. In this in-
stance, the duration of the depressive episode was not brief relative to the total duration of
the psychotic disturbance, and thus the presen tation qualifies for a diagnosis of schizoaf-
fective disorder.
The expression of psychotic symptoms across the lifespan is variable. Depressive or
manic symptoms can occur before the onset of psychosis, during acute psychotic episodes,
during residual periods, and after cessation of psychosis. For example, an individual
might present with prominent mood symptoms  during the prodromal stage of schizo-
phrenia. This pattern is not necessarily indicative  of schizoaffective disorder, since it is the
co-occurrence of psychotic and mood symptoms  that is diagnostic. For an individual with
symptoms that clearly meet the criteria for sc hizoaffective disorder but who on further fol-
low-up only presents with residual psychoti c symptoms (such as subthreshold psychosis
and/or prominent negative symptoms), the diagnosis may be changed to schizophrenia,
as the total proportion of psychotic illness compared with mood symptoms becomes more
prominent. Schizoaffective diso rder, bipolar type, may be more common in young adults,
whereas schizoaffective disorder, depressive type, may be more common in older adults. 
Risk and Prognostic Factors
Genetic and physiological. Among individuals with schizophrenia, there may be an in-
creased risk for schizoaffective disorder in first-degree relatives. The risk for schizoaffec-
tive disorder may be increased among indivi duals who have a first- degree relative with
schizophrenia, bipolar disorder, or schizoaffective disorder. 
Culture-Related Diagnostic Issues