Schizoaffective Disorder
Schizoaffective disorder is a condition that has some aspects of schizophrenia and some of bipolar disorder or major depression. For example, hallucinations, delusions, and disorganized thinking might occur along with symptoms of mania, or severe depression might be accompanied by the disordered thinking typical of schizophrenia.

Treatment approaches for schizoaffective disorder involve an individualized combination of therapies. Antipsychotic medication along with a mood stabilizer is often used. Supportive psychotherapy, case management, and education are also important.

Major Depression
Depression involves a characteristic set of symptoms but represents a diverse group of disorders. Most cases of depression are mild to moderate and short lived. As we’ve seen, depressive symptoms are common in addiction and are also frequently induced by alcohol or drugs. But in some cases depression is severe and prolonged and causes significant impairment in functioning. The condition can be broken down roughly into three types: reactive or situational, devel-opmentally based, and biologically based.

Situational or reactive depression is common in alcoholics and addicts and generally clears with counseling and medication. Developmentally based depression often results from abuse or neglect in childhood or from growing up in a dysfunctional family.

Biologically based depression, or major depression, is a disorder that affects the part of the brain responsible for maintaining mood and handling stress. It can be mild, moderate, or severe. There is often a family history of major depression.

In some cases a trauma has occurred in childhood, such as the loss of a parent, which is severe enough to have affected the development of the brain, leading to a vulnerability to biologically based depression.

Symptoms include a persistently depressed mood, a lack of reactivity of mood to social interaction, slowed thinking, poor appetite, intermittent or early morning awakening, poor concentration, impaired short-term memory, and morbid preoccupation. Thoughts of suicide are often present, and there is a risk of suicide attempts. Some abnormalities in endocrine functioning have been noted, such as a blunting of the responsiveness of the thyroid gland and failure of the adrenal gland to respond to the presence of a test dose of dexamethasone (a steroid). In severe cases there may be hallucinations and delusions, often with morbid or depressed content.

Major depression usually responds to treatment with medications along with psychotherapy, but sometimes depression is resistant to treatment and leads to chronic problems with concentration, mood, and self-esteem. Addicts with treatment-resistant major depression often have difficulty with recovery since they do not share the apparent benefits of abstinence with their peers. They may also be overly sensitive to confrontation and have difficulty with the middle steps of a 12- step program.

Elizabeth Connell Henderson, M.D.

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information