SCHIZOAFFECTIVE DISORDER ??? AN ISSUE OF DIAGNOSIS
Lee Jie Jonathan, Kuan-Tsee Chee, Beng-Yeong Ng
Objective: To highlight the diagnostic challenges in diagnosing a patient with schizoaffective disorder under DSM-IV-TR and to evaluate the effectiveness of changes in DSM-V in addressing these issues. Methods: We present the evolution of the diagnosis from its inception, outline its complex nosology, review the diagnostic difficulties under DSM-IV-TR and critique the proposed changes made in DSM-V. Results: A complex nosology, varied thresholds of diagnosis under DSM-IV-TR, and the inherent difficulty in obtaining a detailed longitudinal history from a patient contribute to the challenge of diagnosing a patient with schizoaffective disorder. Changes in DSM-V attempt to increase the reliability of the diagnosis by specifying and raising temporal thresholds, moving the time of disease observation away from a single episode but towards the lifetime of illness. Conclusion: Changes made in DSM-V only address a small part of the difficulties raised and clinicians will continue to face challenges in diagnosing schizoaffective disorder under DSM-V. However, there might still be value in the proposed changes under DSM-V.