Pathogenesis The etiology and pathogenesis of the disease have not been clarified to date, but in general terms it may be the result of a combination of genetic, endocrine, and psychosocial factors. Genetic factors Controlled studies of first-degree relatives have shown that the disease is genetically intermediate between schizophrenia and affective psychosis, and family surveys of schizoaffective prevalent individuals have reported a higher prevalence of mood disorders or schizophrenia than the general population, mostly supporting a relationship with mood disorders and schizophrenia. Neuroendocrine studies The results of neuroendocrine studies of schizoaffective disorders are divergent. For example, the rate of disinhibition in the dexamethasone suppression test is low in the schizoaffective depressive type, close to schizophrenia and normal controls, unlike the high rate of disinhibition in major depression. Similarly the response to thyroxine and prolactin in response to injection of thyrotropin-releasing hormone is similar to schizophrenia and normal controls in schizoaffective psychotic patients and is not retarded, unlike the response in major depressive patients. Genetic hypothesis: 1. Combination of two genes: Data from controlled studies of first-degree relatives indicate that the disease is genetically intermediate between schizophrenia and bipolar disorder, inferring that the disease is a combination of two genes for two genetic disorders – schizophrenia and bipolar disorder. However, this hypothesis contradicts clinical practice. If schizoaffective disorder has genes for bipolar affective disorder in addition to schizophrenia, its prognosis should be worse than both of these disorders, but this is not the case. 2. Continuity pattern hypothesis: DSM-IV divides schizoaffective disorders into depressive and biphasic types. This hypothesis suggests that monophasic, biphasic, schizoaffective psychosis and schizophrenia are on a continuum from yellow-yellow-green-green-blue-green-blue, with schizoaffective psychosis as a green disorder, schizophrenia as a blue disorder, and biphasic as a yellow disorder. The bipolar type is close to traditional affective psychosis, and the depressive type is close to schizophrenia. Disease classification 1. Manic type: Both schizophrenic symptoms and manic symptoms are prominent in the synonymous episodes of the disease. 2. Depressive type: Both schizophrenic symptoms and depressive symptoms are prominent in the synonymous episodes of the disease. 3, mixed type: both schizophrenia symptoms and mixed affective disorder symptoms are prominent in synonymous episodes of the disease. Clinical manifestations 1, symptoms of schizophrenia: main hallucinations, disorders of thought form, disorders of thought content and other positive psychotic symptoms, such as: hallucinations, various delusions, thought being broadcast, thought being taken away, thought insertion, sense of inner being revealed, pathological symbolic thinking, new work of speech, etc. 2, affective symptoms: refers to the performance of manic or depressive episodes. Manic episodes mainly manifest as high emotion or irritability, accelerated thinking association, increased activity, reckless behavior, high self-evaluation up to delusions, reduced need for sleep, and hyperactive instinctive activity, etc. Depressive episodes are mainly characterized by depressed mood, decreased interest, lack of pleasure, decreased energy, difficulty in association or decreased ability to think consciously, recurrent thoughts of death or suicidal or self-injurious behavior; low self-evaluation, self-blame and guilt or even up to delusional level, sleep disorders, decreased appetite and libido, weight loss, etc. Diagnostic criteria Since the cause of schizo-affective psychosis is currently unknown, psychiatrists have so far relied mainly on the patient’s medical history provided by the family, detailed psychiatric examination, and diagnosis in strict accordance with the current diagnostic criteria at home and abroad. Of course, physical examination, scale tests, laboratory tests, and imaging tests also play a necessary supporting role in the diagnosis. Regarding the diagnostic criteria of this disease, the commonly used ones in China include the Chinese Classification and Diagnostic Criteria of Mental Disorders, Third Edition (CCMD-3), the International Classification of Mental and Behavioral Disorders, Clinical Description and Diagnostic Highlights, Tenth Edition (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). 1. Diagnostic criteria of CCMD-3 for schizoaffective disorder: 1. Symptom criteria: Meet the symptom criteria of both schizophrenia and manic episode or depressive episode of affective psychosis. 2. Severity criteria: severe impairment of social function and incomplete or lack of self-knowledge. 3.Course of illness criteria: schizophrenic symptoms and affective symptoms that meet the symptom criteria exist simultaneously for at least 2 weeks throughout the course of the illness, and the time of appearance and disappearance is relatively close. 4. Exclusion criteria: Exclude organic mental disorders, psychoactive and non-addictive substance-induced mental disorders, schizophrenia, and affective mental disorders. ICD-10 diagnostic criteria for schizoaffective disorder:: 1. The disorder has one of the criteria for moderate or severe affective disorder. 2, one of the following symptoms must be clearly present for at least two weeks (these symptoms schizophrenia visible, almost identical). 3. 1 and 2 above, must be present during the same episode of the disease or at least part of the episode. Both must be evident in the clinical phase. 4. The disorder is not due to organic mental disorder or psychoactive disorder – intoxication, dependence or withdrawal. 3. DSM-IV diagnostic criteria for schizoaffective disorder: 1. An uninterrupted disease process during which major depressive episodes, manic episodes, or mixed episodes with symptoms consistent with schizophrenia may occur. 2. The presence of delusions or hallucinations for at least 2 weeks during the same phase of the illness, in the absence of overt mood symptoms. 3. Symptoms consistent with a mood episode occur during the active or residual phase of the illness. 4. The disorder is not caused by the direct physiological effects of substance dependence or a systemic medical condition. Differential diagnosis The diagnosis of schizo-affective psychosis can only be made after first ruling out temperamental psychosis, schizophrenia and affective disorders. The diagnosis of schizoaffective psychosis is made when the typical symptoms of schizophrenia, mania, mixed or depressive episodes of equal low severity are also present. Disorders that need to be differentiated include: 1. Schizophrenia with depression This occurs frequently and is characterized by the presentation of common psychotic symptoms rather than the rare symptoms of schizoaffective psychosis. Patients also have negative symptoms of schizophrenia, with a longer duration of symptoms and a slow and incomplete recovery. 2, schizophrenia with mania Schizophrenia with a higher emotional state differs from schizoaffective psychosis in that the emotional high lasts for a shorter period of time and is usually accompanied by emotional disturbances, such as unemotional dissonance, that do not resonate pleasantly with the people around them. 3, with psychotic symptoms of affective disorders When the psychotic symptoms of affective disorders are coordinated with emotions, it is not difficult to distinguish from schizo-affective psychosis. However, if the psychotic symptoms are not coordinated with the affective disorder, it is more difficult to distinguish, and its main clinical manifestations are manic episodes or depressive episodes, while the psychotic symptoms are relatively few and short-lived, accounting for only part of the entire course of the disease. Patients suffering from mental illness are suffering from mental and even physical pain, which obviously affects the quality of life of patients and their families, and affects their social functions such as family and occupation. Once the diagnosis is established, a reasonable overall treatment plan should be formulated. In the acute stage, the first and foremost thing is to take strong measures to alleviate the patient’s suffering, relieve the symptoms, and prevent the occurrence of various risks such as self-inflicted suicide. , educational, and vocational support and rehabilitation to promote the recovery of social function.