In contrast to the considerable systematic study of the pharmacologic treatment of
schizophrenia and
mood disorders, the pharmacologic treatment of
schizoaffective disorder has been relatively ignored. The authors reviewed the available literature regarding the pharmacologic treatment of
schizoaffective disorder. The total number of controlled studies of the acute and prophylactic treatment of
schizoaffective disorder was small and few used modern criteria to define the disorder. In studies of
schizoaffective disorder, bipolar type (manic),
lithium and
antipsychotics produced comparable albeit incomplete responses, except in highly agitated patients when
antipsychotics exerted superior efficacy. The combination of
lithium and
antipsychotics appeared to be superior to
antipsychotics alone for schizoaffective, bipolar type patients. In the only controlled study of
schizoaffective disorder, depressed type, the presumed superiority of combined
antidepressant and
antipsychotic treatment to
antipsychotic alone was not found. Although combined
antipsychotic and
thymoleptic treatment represents common prophylactic management of
schizoaffective disorder in clinical practice, the efficacy of this strategy has not been studied in controlled trials. Advances in the nosology of
schizoaffective disorder, emerging epidemiologic data demonstrating large numbers of patients with this disorder in clinical populations, and preliminary evidence that
clozapine may have combined
antipsychotic and
thymoleptic properties as well as efficacy in both the psychotic and affective components of
schizoaffective disorder, suggest that renewed interest in the diagnosis and treatment of this disorder may lead to improved delivery of care for this understudied but seriously ill group of patients.